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07/30/2003 11:30 209-579-E'1?+5 MODESTO ATC PAGE 01 <br /> EHO LOG'KUMBER - <br /> DATE. <br /> M�C E6 I - '.•;; ._� - SAN JOAQUiN COUNTY <br /> ;. <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 3 ��a3 304 EAST WEBER AVENUE,THIRD FLOOR <br /> JUL <br /> STOCKTON CA 95202 <br /> I l L (209)468-3420 <br /> �.1141.f 1175.1+1v1ti'l'_�'� ��:r r51_�iy <br /> PUBLIC RECORDS RELEASE APPLICATION , <br /> Q7' Sa F CS <br /> VNp�r-t' BUSINESS/AGENCY <br /> APPLICANT <br /> Kl <br /> k� L P-1t, Ave Ste. c <br /> ADDRESS ' 1-222S <br /> PHONE <br /> 20q-59'222 FACSIMILE <br /> ycti7x TIME <br /> TENTATIVE"APPOINTMENT DATE J1 . <br /> (Please glia 7 to 10 buslnasa days from date of appllcatlon subrnitial) <br /> gg 0 FEE- PROCESSED IN 3 BUSINESS DAYS <br /> ❑ CHECK BOX TO EXPEDITE REQUEST S DATE <br /> SIGNATURE OF APPLICANT � <br /> 7 <br /> THIS SIDE EHD STAFF USE ONLY <br /> FILE ADDRESS PROGRAM ELEMENTS S CH - <br /> I I <br /> I "- t s ., <br /> y <br /> nil 357 <br /> S._11r5-iorJcc <br /> J <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT SOLID WASTE FACILITY <br /> SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL d DAIRY <br /> ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR ❑ MOTELIHOTEL C3 PUMPER'TRUCKIYARDICHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY 0 LAND USE APPLICATION SITES <br /> ❑ TATTOOlSODY PEIRCING ❑ POOLISPA <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECEFY} <br /> 1. List_up to ten addresses in the space above. Select the.type(s)of files frnmlthe list above by checking _ <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209 464.0138 or ail to t to <br /> address Indicated above. <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 tfian ten(10)days after receipt of application. The files <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,immedlately 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$86.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be conflrrned with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day.. <br /> CONFIRMED AP.POIN7MEN7 t7ATE <br /> .DATE CONiFIRMED:.. PHONE FAX INITIALS <br /> ltVlluVfD' _. YES N4 ,... . FtE111E1N'pAT�':.. <br /> EHD/842401 - - .• <br /> ]12&700] <br /> II <br />