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08/29/2003 15:23 209-579-2225 MODESTO ATC PAGE 01 <br /> EHD LOG NUMBI <br /> DATE RECEIVED * SAN JOAQUIN COUNTY <br /> ( ((cc, ENVIRONMENTAL HEALTH DEPARTMENT <br /> (fll LC �� )Il�h� 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> (209) 41 8-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> AUG 2 9 2003 <br /> pp PUBLIC RECORDS RELEASE AAPPLICATION <br /> APIiLICANTT�S T ' .S1 BUSINESS/A6ENpCY: �/}T /�tC' �S�;o�tcldref �C <br /> ADDRESS: /1/-7 Zalc Palin AvfSurte 1J /p (Cd(d� < ��•3•Sr <br /> PHONE: go?— .579 ��?r FACaiMILE: S�I7' �2�a"r - <br /> TENTATIVE'APPOINTMENT DATE: SP-'t? /2 .z�3 Time: o <br /> 800. <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST�$937 0000 FEE.—,ORE/QUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /;ZI ! DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> p Unit 1 <br /> streetD Inco 1)7i 4 O rp/?CA f't33L <br /> )It AIf ° so-.« nn V'/r Cr, LONa$c.t 9�J3 ✓� ❑ Unit 2 <br /> 2950/$ a ae ppOO i s M1 am /Ya#rh 3 <br /> 3 5 ave« 98 t v a sN7t ct r33� Unit 3 G <br /> !/35 M L O a.A2 9 J <br /> 7. street A / S`4 CI nq/itfA QSJ?6 Unit4 <br /> 9. y,,,, O p Unit 5 <br /> is strep a <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Sill UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> Q OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> t9 UNDERGROUND TANK(MONITORINGlREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> N HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETE <br /> O TATr0015ODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE-SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type($) of flies from the list above by checkin <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)404-0138 or mall to the <br /> address Indicated above. <br /> 2. EHD will notify the applicant K any EHD flies exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt of application_ The flies <br /> will be held 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 revleW. A nt <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 expen: <br /> of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to revit <br /> 3. '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 DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> w«axon <br /> srorsooa <br />