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IF'Alak r n1 _ .. <br /> 09/11/2092 16:07 209-•579 2225 MODESTO ATC <br /> f <br /> S IN COUNTYPUBLIC HEALTH SERVICES E11 €.�PQ <br /> ENVIRONMENTAL HEALV HEALTH DIVISION �'J! <br /> 304 EAST WESER AVENUE.THIRD FLOOR f <br /> SEP 2 2002 STOCKTON CA 95202 S E P 1 2 2002 <br /> (209)460-3420 <br /> ENT HEALTH PUBLIC RECORDS RELEASE APPLICATION ENVIRONMENT HEALTH <br /> /S�KVR,�L F1 Is- <br /> APPLICANTTM� � BUSINESSIAGEHCY <br /> ADDRESS <br /> PHONE � FACSIMILEO <br /> � )S� <br /> TENTATIVE"APPOINTMENTDATL / " TIME <br /> (Plc»xe give 7 to 19 business da Irel o of ap kation:Ubmlll�) <br /> CHECK8.OX TO, CPEDITE REQUEST- 7.0 QUkS PROC• S D I 1 ausimess DAYS <br /> :3 <br /> SIGNATURE OF APPLICANT DATE 911, car <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 1 c <br /> tk n 1 <br /> ap ,r_ <br /> t3 E o <br /> C <br /> L-. ° x4 <br /> 4 6t45 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> )W-UNDI:RGROVND TANK(VST)CLEANUP SITE(LOP) d HOUSING ABATEMENT 0 SOUR WASTE,FACILITY <br /> OTHER CLEANUP SITE(NOWLOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) 10 000 KENNEL - O.DAIRY <br /> ❑ HAZARDOUS WASTE GENCRATOR O CHICKEN RANCH O PKG TREATMENT PLANT l <br /> ❑ TICR90PERMiTTDFACILITY 0 IMIOTF-UH10TEL C3PUMPER TRUCKfYARDICHEMTOILETS <br /> ❑ TATTOOISODY PJACING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL.WA5TI'FACILITY 0 PUBLIC wATCR SYSTEIN O OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ton addresses In the space above. SaleCt the type(S) of files from the list above by chcekinrd <br /> t.ie appropriate box(es). At least one file type MUST be Selected. Fax to 209 464-PI38 or mail to the <br /> address indicated al ove. C <br /> 2. !_HD 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 tan(10) days after receipt of application.-The files <br /> will be held for a maximum of five business days for eaview. 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 now <br /> application may be submitted when the fits is available. <br /> 4. Any file not returned in the same condition as rciea3ad will be reorganized by EHO staff at the expense <br /> of the applicant.`Future file reviews by the same applicant may require a$67.00 deposit prior to review. n I <br /> 5, ".TENTATIVE appointment dat4s must be confirmed with EHD staff. <br /> 6. Applications received after 3,00 pm will be procossotl the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED, PHONE FAX INITIALS z <br /> - 4 <br /> REVIEWED .+ YES NO REVIEW DATE <br /> Eli oe a ,o los , <br />