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fI11I—_ 1/ 0 II003E 16 : 20 209 -579-2225, MODESTO ATC PAGE 01 <br /> L SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES � � ���� • <br /> NOV 1 0 2003 ENVIRONMENTAL HEALTH DIVISION <br /> ENVIRONMENT HEALTH 304 EAST WEBER AVENUE, THIRD FLOOR <br /> PERMIT/SERVICES (209)STOCKTON 3 95202 <br /> 46$-m3420 1 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT r,-w sie ^ Mie-. BUSINES5IAGENCY � G <br /> ADDRESS I Loup of .n ,lt , S,.4•t D . pI(Qu ar o ( f4 <br /> PHONE zQ s — OLO Cl PACSIMIL//E�� L`❑ �l S ^ 2 '[ "t- p <br /> TENTATIVE" APPOINTMENT DATE I V3 TIME CY 3 .40 <br /> (PI0a5c give 7 to ie buainuss Gays from d310 of apPlicnlion supolmol) - <br /> ❑ CHcciC eOX TO,LXPEDITE REQUEST " 567.00 FEE,, rr REQUE,SAT PROCESSED IN 0 DUSINEss DAYS <br /> SIGNATURE OF APPLICANT DATE _- 0 /IAAS <br /> FILE ADORE55 THIS SIDE EHD STAFF USE ONLY <br /> 11 PROGRAM ELEMENTS 59ARCH <br /> QZ � U` ' t Wvt I a 1 11 <br /> SX <br /> 1 ;f �' l or• do `14 �1 L <br /> �27Z 4� 56 Etc rs ciao S (r•+F Frw �M Ca �7 <br /> •oo L� .q . d Sn <br /> q5a o h Cr. G o7 <br /> y,/ ENVIRONMENTAL HEALTH DIVISION FILES <br /> 4f UNDERGROUND TANK (UST) CLEANUP 51TE CLOP) ❑ HOUSING ADATEMENT O SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK (MONITORING/REMOVAL) ❑ 1300 KENNEL ❑ DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITT40 FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKlYARDICHCM TOILETS <br /> ❑ TATTOOMODY PUIRCING ❑ POOUSPA `• ' ❑ LAND USE APPLICATION SITES <br /> MEDICAL WA5'fC f•ACILITY 0 PUDLIC WATER SYSXEM ❑ OTHER (PLEASE SPECIFY ADOVE) <br /> 1 . List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> the apprapriato box(es) , At ( cast one file typo MUST be selected. Fax to (209) 454-013 $ or mail to the <br /> aggres5 'indicated above , <br /> 2. EHD 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 ton (10) days after receipt of application. • Tho files <br /> will be held for a maximum of five business days for review. Appointments should be Scheduled <br /> accordingly. <br /> 3 . A file that is actively being worked on by ,EHD staff may not be immediately available for review. A new <br /> dpplication may be submitted when the file is available. <br /> 4 • Any file not returned in the same condition as released will be reorganized by EHD staff at the CXPCHLe <br /> of the applicant, Future file reviews by the same applfeant may require a $07.00 deposit prior to review. <br /> 5 • "TENTATIVE appointment daleps must be confirmed with EHD staff, <br /> 6 . Applications received after 3 ; 00 pm will be processed the next business day. <br /> . I <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX <br /> INITIALS <br /> REVIEWED <br /> NO REVIEW nI <br />