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09/11/2002 16:07 209_ ',9-2225 MODESTO ATC r- PAGE 01 <br /> EC� `���� [}� s IN CO <br /> UNTYPUBLIC HEALTH SERVICES ��~(�r�~;� <br /> RD 1 ENVIRONMENTAL HEALTH DIVISION 11 1J � <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> SEP 2 2002 STOCK rON CA 85202 SEP .1 2 2002 <br /> (209)468-3420 <br /> ENT HEALTH PUBLIC RECORDS RELEASE APPLICATION ENVIRONMENT HEALTH <br /> pERMI <br /> APPLICANT O 8USINESSIAGEN(�CY <br /> ADDRESS �� �� , V Q S-) <br /> FACSIMILE Q �j <br /> TENTATIVE'APPOINTMENT DATE 1A 73, TIME <br /> (Plcuc Viv?t!R' C <br /> Irol C dl ap lC�l[arl 3u�mlilal} - <br /> CilE' Box TO,ExPE171TE RE( <br /> lUCST- • 5 D 1 7 BUSINESS PAYS <br /> SIGNATURE OF APPLICANT DATE 9 Ir tJL <br /> FILE ADDRESS THIS SIDE EHO STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCHlit a <br /> � <br /> PULA-Cy <br /> r 5 <br /> CFO <br /> l! 13 1Co <br /> 0 1 vi 01 <br /> vets <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> W—UN08RGROVND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OX OTHER CLEANUP SITE(NON-LDP) • Q FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNoaRCROUND TANK(MONMORINGIREMOVAL) O DOG KENNEL O DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR O CHICKEN RANCH D PKG TREAYmENT PLANT <br /> ❑ TIERED PERMITTD FACILITY ❑ MOTEL/HbTI;L 13PUMPER TRUCKlYARDICHEM TOILETS <br /> a TATTOOIBODY PJJACING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTd FACILITY O PUBLIC WATCR SYSTEM O OTHER(PLEASE SPCCIFY ADOVE) <br /> 1. List up to ten addresses In the space above. Select the type($) of files from the list above by checking <br /> ttie appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to tho <br /> addr ss indicated a eve. I I <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 ten(10) days atter receipt of application.-The files <br /> will be held for a maximum of five business days for review. Appointments should be sch'cduled <br /> accardingly- <br /> 3. A file that is actively being worked on by EHD staff may not.be imrmediatoly availabic for review. A now <br /> application may be submittacl When the fits is availablo. <br /> 4. Any file not returnod in the same condition as rcleasod will be reorganized by EHA staff at the oxpcnSe <br /> of the applicant. Future file reviews by the same applicant may require a$87.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EKD staff. <br /> 6- Applications received after 3:00 pm will be procossed the next business day. <br /> CCNFkRMED APPOINTMENT pA 'CIM ' <br /> DATE CONFIRMED PHONE F INITIAL$ <br /> REVIEWED • a Yt=S <br /> x a0 a 0 �vp <br />