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09/11/2002 16:07 209--57.92225 <br /> MODESTa ATC PAGE 01 <br /> 94 <br /> GEy1��f] c S IN COUNTYPUBLIC HEALTH SERVICES r , n <br /> V ��' � ENVIRONMENTAL HEALTH DIVISION -01 EXEINE�-1 <br /> 304 EAST WESER AVENUE.THIRD FLOOR <br /> SEP 2 2002 STOCKTON CA 95202 SEP 1 2 2002 <br /> (209)468-3420 <br /> EN1 HEAL`[ A PUBLIC RECORDS RELEASE APPLICATION ENVIRONMENT HEALTH <br /> APPLICAnR7Ml e3 BUSINESSIA13ENCY2nc. ja t <br /> ADDRFSS 1I- h V C� 1l'3 <br /> PHONE — }FACSIMILE Q <br /> TENTATIVE-APPOINTMENT DATE / A ii lTIME <br /> (Piaa4v give 7 to 10 business daa frolNiWo or apjolcaklon:ubmn aq <br /> u CHECK BOX TO eXPEDITE REQUl:ST- 7.11 !Q!-03ARQC 5 D t 3 BVSINE$S DAYS - <br /> SIGNATURE OF APPLICANT DATE 1/) <br /> crL� <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> ll-- PROGRAM ELEMENTS SEARC" <br /> W km AH P4� �• <br /> 5to-'e44, <br /> 22 C'6 4 <br /> ISS F 'o <br /> 4 <br /> d 14 Gus <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK LUST)CLEANUP SITE(LOP) ❑ HOUSING AuATEMENT ❑ SOLID WASTE FACILITY <br /> ,,OTHER CLEANUP SITE(NOF!-LOP) Q FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MORITORINGIRF-MOVAL) 0 DOG KENNEL 0' DAIRY <br /> I-] HAZARDOUS WAsTr-GENCRATOR O CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITT D FACILITY C2MOT1:11HOT>L 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> O TATTOOMODY PIJQZCING 0 POOUSPA 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WAS-rd FACILITY Q PUBLIC WATER 5YS-TCM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ton addresses in the space above. Select the typc(s) of files from the first above by checking <br /> ttie appropriate box(es), At Ieast one file type MUST be selected. Fax to (209)464-0138 or mail to the <br /> addrgss indiCated a�ave. <br /> r <br /> 2. EHO will notify the applicant if any EHD files exist. An appointment For review will be confirmed <br /> approximately five business days but no later than ten(10) days after receipt of application.-The files <br /> will be held for a maximum of five business clays for review. Appointments should be sch'cduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A now <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHO Staff at the oxpcnse <br /> of the applicant. Future:file reviews by the same applicant may require a$87.00 deposit prior to review. <br /> 5. `TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE . TIME <br /> DATE CONFIRMED_ � _ PHONE FAX INITIALS <br /> REVII=WFD yEs NO REVIEW DATLO , <br /> N OO u O J00 <br />