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09/11/2002 16:0720f '75-2225 MODESTO ATCf _PAGE' 01 _ <br /> �. �f <br /> -. r <br /> DBEV _� IN COUNTYPUBLIC HEALTH SERVICES 4�u (�.�c �� 5 ENVIRONMENTAL HEALTH DIV � 1� <br /> ISlOIV <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> SEP 1 2 2002 STOCKTON CA 95202 SEP 1 2 2002 <br /> (209)469-3420 <br /> EfVT HEALTH PUBLIC RECORDS RELEASE APPLICATION ENVIRONMENT HEALTH <br /> APpL1CAN.r o <br /> } i3U51NE551AGENCY <br /> ADDRESS <br /> PHONE }FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Plcaac flivo 7 in 70 buzlnCsi da frill a oVap Icsllon�ub�tdtlaf}' 313 <br /> El CHECK BOX TO,EXPkDITE REQUEST• 70 QUkS PROC 5 DUSINESS DAYS <br /> SIGNATURE OF AiPLICANT <br /> DATE 9 II cry <br /> FILE AOORESS THIS SIDE EHO STAFF USE ONLY <br /> PROGRAM GLEMCNTS SEARCH <br /> l � c <br /> n <br /> CFO IV <br /> lIV j13 F .0 <br /> G <br /> Q Gt.�Se <br /> ENVIRONMENTAL HEALTH DIVISION FILES � <br /> �-UNDERGROUND TANK tUST)CLEANUP SITE(LOP) O HOUSING ABATEMENT 0 SOt,ID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON•LOP) 0 FOOD FACIUTY ❑ SOUD WASTE VEHICLC <br /> ❑ UNDERGROUND TANK(MONiTORINGIREMOVAL) O DOG KENNEL la.DAIRY <br /> ❑ HAZARDOUS WASTC-GENCRATOR O CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> © TIERED PERMITTD FACILITY 0 MOTEIIH'bTEL ❑ PUMPER TAUCKlYARDICHEM TOILETS <br /> 0 TATTOOIBODY PACING a POOLJSPA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL WAST9 FACILITY Q PUOLIC WATER SYSTEM ❑ OTHER(PLEASE SPCCIFY ABOVE) <br /> 1. List up to ton addresses In the space above. Select tho type(s) 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 the <br /> addr ss indicated a Eve. ., <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed r <br /> approximately five business days but no later than tbn (10) days after receipt of application.-The fifes <br /> Will be held for a maximum of five business days for review. Appointments should be scheduled <br /> p <br /> p <br /> accordin!)ly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediatoly available for review. A now <br /> application may be submlttecl when the file is available. <br /> 4. Any file not returnod in the same condition as releasad will be reorganized by EHO staff at tlle <br /> expense i <br /> of the applicant. Future file reviews by the same applicant may requiro a 587.00 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 DA 'CIM <br /> DATE CONFIRMED PHONE F INITIALS <br /> REVIEWED YES <br /> a o0 <br />