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05/03/2006 11:34 209-579-2225 MODESTO ATC PAGE 02 <br /> DATE RECEIVED EHO LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 But Weber Avenue,3`6 Floor,Stockton,CA 95202-2708 <br /> Telephone: (209)468-3420,Fax:(209)464.0138 Web: www.sjgov.org/thdZ351PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ��LVf71�"alwwa BUSINESSIAGENCY:_A_'S, A-st <br /> ADD'RESS:�11 Le-t,11VL�ALwR: ,fiji:. f�r.p —� L� (-A <br /> PHONE(1): IVMI 2=1711 PHONE(2): FACaIMILOoE: _Z12 <br /> TENTATIVE"APPOINTMENT DATE: 5,1°l•c4E. Tirtle: ?IAA— <br /> , <br /> allow 10 business days from date of application submRtal-"Tantw"only-must be confirmed) <br /> CHECK BOX TO EXPE RF�7)E/S(�/T :93.00 FEE(CASH OR CHECK ONLY)-RECIUE3T PROCESSED IN 9USMESa DAYS <br /> SIGNATURE OF APPLICANTG2` DATE _�-�• � <br /> UNITDISMBS ;ON 0unk1 0Unit 2 XU.Its 431 Unit4 0Unit 5 Unke 0 OTMr(olsetronlcAltt&m s) <br /> FILE ADDRESS 40NL7 <br /> straa s street Noah city <br /> PVT C bAsw t, <br /> 2. 70 a /f <br /> --- ..!t__..—._._...._........... <br /> 4. 1 <br /> 5. Pr� fl.SpecNlo Date Range of Information Requested:From fA S"T"" to <br /> ENVIRONMENTAL HEALTH DEPARTMENT.oF.IIL,E�S' <br /> TpA UNOERORWND TANK(UST)CLEANUP SUE(LOP) O Hotjxjw AaATEMENT Wy,�D WAsi. FACILRYN¢HICLE <br /> 1,OTHER CLEANUP SDE(NON-LOP) ❑FOOD FACILITY 0 WAsn!TIRE <br /> UNDEKOROUND TANK(MONRORINWMENOVAL) EI Oce KENNEL ❑DAIRY <br /> R HAaAK000L WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> Psnimro PERMrrml)FACILITY 0 MOTELMOTEL ❑PUMr'EKTKUCK(YAKDICHEMTOILM <br /> 0 TATTWMODY PICKING 17 POOLMPA D LANG Us.E APPLICATION EDEA <br /> 19 MEDICAL WASTE FACILrrY 0 OTHEa(PLEASE SPECIFY) <br /> WELL ANO SEPTIC PERMfT RECCROS ARE AVAILABLE FOR RENEW- MONDAY-FMDAY COD AM-5;00M . EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fan to(20191464.0138 or mail to the address <br /> indicated above. Address ranges will not be accepted-for additional assistance with fife addrsssos,contact <br /> the EHD.Applications received after 3;00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed <br /> approximately ten (10) days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A fife that 19 actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file Is available. <br /> 4. Any file nog returned in the same condition as released will be reorganized by EHD staff at the expense of the <br /> applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHo�aezaa <br /> vtwae <br /> r <br /> T <br />