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07/02/2003 08: 35 209-579-2225 MODESTO ATC PAGE 01 <br /> V^ c~ • SAN JOAQUIN COUNTY e'm LCq Muwara <br /> ENVIRONMENTAL (HEALTH DEPARTMENT <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> J U L 0 L003 STOCKT'DN CA 95202 <br /> (209)466-3420 <br /> BLIC RECORDS RELEASE APPLICt1,T701J <br /> APPLICANT O r AI G V� /4-1�.[,./\ BU81NESWAGENCY /4 rC �• <br /> ADDRESS (I Ip'I 1,'I f CAt.V1 Ay, Sv7'k b_ <br /> PHONE Z b ` S•}5— Z Z'C l FACSIMILE Z.NO Q S 9 Z Z. <br /> TENTATIVE'APPOINT <br /> ENT DATE TIME � � <br /> (Please plus 7 to 10 business de.m from data of application subiidti:■q <br /> CHECK BOX TO EXPEDITE REQUEST-589.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAY'S Mot .,A C'Vq <br /> SIGNATURE OF APPLICANT DATE <br /> a FILE ADDRESS THIS SIDE I_HD UTAFF 1173E ONLY ^� <br /> PROGRAM ELE..IIE";SE)NCH <br /> _ _ _— <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SCIJD WAIITE I°AGILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FA ClLrrY ❑ 80 LID WA:3TE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ 000 KENNEL ❑ DAIRY <br /> O HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKQ TREA''.IAAENT PLANT <br /> ❑ TIERED PERMITTED FACILITY O MOTEL/HDTEL ❑ PUMPER 11WCI0YARD/CHEIIt TOILE7:1 <br /> ❑ TATTOOIBODY PEIRCING ❑ PODUSPA ❑ LAND USE APPLICATION SWES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER 01-FASE SPECIFY)--._--_-__ <br /> 1. List up to ten addresses in the apace above. Falect the type(s)of flies Imm th a IIII•t above by checking <br /> the appropriate box(ss), At least one file type 'MUST be eslacted. Fax ti! 4: A or m Ila to tFnn <br /> addrestd Indicated above, <br /> 2. EHD will notify the applicant If any EHD flies e:dst. An appointment for rairleW will be confirmed <br /> approximately five business days but no later than ten (10)days after III Ipi It application. The filno <br /> will be hold 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 Immedla tell)avItllable for III A now <br /> application may be submitted when the file is r.'.vallable. <br /> 4. Any file not returned in the same condition as released will be reorganbi;d by IcHD staff at the experms <br /> of the applicant. Future file reviews by the same applicant may require iI 389.00 dnpoell:prior to reVle1V. <br /> S. "TENTATIVE appointment dates must be confitmad with EHD staff. <br /> 8. Applications (received after 3:00 pm will be pro,:essed the next business &y. <br /> . ,r , �77 - <br /> Qnr'Sy�irJMt <br /> r �•-111��4gi�Rw (." L"0.'L". y i}q 57. <br /> aneoeoa <br />