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p <br /> 08/16/2002 11:44 209- --2225, MODESTO ATC PAGE 01_ - <br /> r . <br /> SAN JOAQUIN:C ��f�� ��,�.� , <br /> OUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> �+ 304 FAST WESER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> PUE3LIC RECORDSRELEASE APPLICATION . <br /> ( A AUG 18 2002 <br /> APPLICANT t� irt�+V Ci✓� �`�.� " OUSINCSSIAGENCY AX�- Q _iOi S ��Vl <br /> ADDRESS ltd"}- 1_rAk- a1v�n 1�,�t.�.,-e PERMU4UMICES <br /> PHONE Z�9 ��•• Z2't l y S 3S'l <br /> FACSIMILE Z�9 <br /> TENTATI V E*APPOIMTMr_-NT OATS <br /> (PICasa DIY 7 TIM& Uma <br /> MEQW:STeR <br /> fro Col ap y alion:ubjWL141) <br /> CHECK$OX TOEXFEprr6 REQUEST•�aT.4TV dy�D I <br /> uswcsS DAYS <br /> SIGNATURE (7F APPLICANT' <br /> DATE <br /> FILL ADDRCSS 'I <br /> THIS SIDE CNA STAFF USE ONLY <br /> ( j;( 4, .l T11, 1 Q t4 PROGRAM ELEMENTS SEARCH <br /> 53� �.�e.rl�o .Skol_tt4on m b <br /> (Z 0''1 1,s <br /> oSt•+�n:at 14�c�+.rt Mla�4ct �a <br /> °I t4 k IA-j4, 132 .rr�4t; <br /> 172<!s (vJe. dI St!'brt� E tae <br /> ldy5 tsltit Ckcr r Ufo ce{�on e <br /> Zt`i t �� �raw S�ccu. ,.► � a <br /> Ea S! '. 1,.wc 7.4 54.�cti�o�►� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ADATEMENT- D SOLID WASTF.FACILITY <br /> OTHER CLEANUP SITE:(NON-LOP) Q FOpp FACILITY <br /> UNDERGROUND TANK(MONITpRINGIREMOVAL) CI DOG KENNEL, 0 SOLID VAIRY <br /> VEHICLE <br /> 0 HAZARDOUS WASTE GENERATOR C] CHICKEN RANCH 17 pKG TRC+ATNICNT PLANT <br /> TIERED PE=RMITTqO FACILITY O O PUMPER TRUCKIYARDIC EM TOILETS <br /> ❑ TATTOO/RODY PHIRCING MOTEL/H'CI7EL <br /> 0 MEDICAL WASTE FACILITY POOL/SPA LAND USE APPLICATION SITES <br /> o PUBLIC WATER SYSTEM fD OTHER(PLEASE SPECIFY AGOVE) <br /> 1• List u to ten addresses in the s eco above. Select the WON of files from the list above by chocking <br /> p p <br /> the appropriate box(es)- At leasto <br /> address ine file type MUST be selected. Fax to 2091 464.0138 or mail to the <br /> ndicatCd abovE. <br /> 2 EHD will notify the applicant if any EHD files exist. An appointment for review wiltrbe confirmed <br /> approximately five business days but no later than ten(10)bays after receipt of application..The files <br /> will be hOd for a maximum of five business days for review. 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 new <br /> application may be submitteci when the file is avallabte. <br /> 4_ Any file not returnod in the same condition as rclaasod Will be reorganized by END staff at the expense <br /> Of the applicant. Futuro fife reviews by the same applicant may require a$07,00 da'posit prior to review. <br /> • 'TENTATIVE appointment dates must be confirmed with I~HD staff. <br /> 6. Applications received after 3:00 pm will be procaSSed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE <br /> FAX INITIALS <br /> REVIEWED NO � -- <br /> tr+ o I, _a roe REVIEW DATE <br />