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'7:� 2�I3� 209-579-2225 MODESTO ATC MAGE 01 l <br /> ,4i I <br /> '' �r� END LOCI NllUMM <br /> !SAN JOAQUIN COUNTY Fr' <br /> sEp 0 4 2003 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> WRL1WOtc-NT HEALD STOCKTON CA 95202 L 16 <br /> Pf M4TrSERVICI 5 )468-3420 <br /> PUBLIC RECORDS�RELEASE APPLICATION <br /> APPLICANT VIAn1 v` Ak`k" BUSINESSIAGENCY A � ) <br /> ADDRESS M ��4"tC- �l f J�•l�r{ ��. 1[ !"IQ�t�� - �J� (� <br /> PHONE FACSIMILE <br /> TENTATIVE-APPOINTMENT DATE "ItYL.C13TIME 09 <br /> (Plsaas give T,to'lo bualneaa days from date Df application autunittal) • <br /> CHECK BOX TO EXPEDITE REQUEST-;$9,l)0`1=If E-REQUEST PROCESSED IN;BUSINESS DAYS <br /> SIGNATURE OF APPLICANT S v DATE _`1j-314:5 <br /> THIS SIDE EHD STAFF USE ONLY <br /> FILE ADDRESS PROGRAM ELEMENTS SEARCH <br /> Z35 <br /> Z� 5�=ma. <br /> t W-t •eel: Aji.Av+ 'tji <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> VUNDERGROUND TANK(UST)CLEANUP SITE(LOP,) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY r <br /> OTHER CLEANUP SITE(NON-LOP) M FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONfITORINGIREMOVAL)., Q Dot;KENNEL O DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR © CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> 0 TATTOWBODY PEIRCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> .1. List up to ten addresses In the apace above. Select the types)of files from the list above by checking . <br /> the appropriate box(es). At least one file type MUST.be selected. Fax t 0 464-0138 or mqI1 to the <br /> ad r indicated ve. <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 after receipt of appilcation. The files <br /> will be held for a maximum of fiveJbuslness days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EMD staff may not be Immediately available for review. Anew- <br /> application 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 expense <br /> of the applicant. Future file reviews by the same applicant may require a$39.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3.00 pr► will be processed the next business day. <br /> fiFfP01lTdA`i" yqyy <br /> IQATt COMM! W 'ANITLALS <br /> it�11NT1ilE� <br /> NO- <br /> W104"2405 <br />