Laserfiche WebLink
05/03/2006 11:34 209-579-% & MODESTO ATC PAGE 02 <br /> p� <br /> DATE RECEIVED EHp LOG NUMBERS y�+t)AQt3IN CO$.1PT'Y"Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT W00% mono <br /> 304 East Weber Avenue,3'4 door,Stookton,CA 95202-2708 <br /> Telephone;(209)468-3420 Fax;(209)464-0138 Web:www.sjgov.or&hd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:txN SUSINESSIACENCY: Amp.; A <br /> PHONE(1): % PHONE(2): FACSINLE: • = <br /> TENTATWW APPOINTMENT DATE: 5'1 l c)&t, " TIM: �A�-- <br /> (Ploaso allow 10 business days from date of applicatlon submittal-*TwnV#m only-must be confirm <br /> CHECK BOX TO EXPE E $93.00 FEE(CASH OR CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINE.r'S DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION 0 Unit 1 0 Unit 2-- Unit 3 Unit 4 ®Unit 5 Unit B ❑ OthMr(®foctr�mlcllfr ) <br /> FILE ADDRESS EHD 118E ONLY �: ' <br /> Stn Stmet Nona city r <br /> 2. 101 Arap <br /> P- <br /> 6. <br /> 'T. <br /> S. <br /> 9. <br /> 10. <br /> Specific Date Range of information Requested,From <br /> ENVIRONMENTAL HEALTH DEPAffMENT FILES <br /> UNDEROwuno Tarso(UST)CLEANUP SITE(LOP) Ci Hommo AnATEmENT 'ft swo WASTE.FAaImAlEHK:LE <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 WASTE TIRE <br /> 10 UNDEPAROUND TANK(MONrrOaING/REMOVAL) 0 DOG KENNEL 0 on" <br /> HAZARDOUS WASTE GENI?a/1TOR to CHICKON RAM" ❑ftsw MATER TREATMENT PLANT <br /> JS TICRZO PERWrMD FAMM ®MOTEUHATEu 0 PumpeRTRuc%NARo1CHEMTaILETs <br /> 0 TATTOOMODY PIERCING ©POOUSPA ®LAND USE APPLICATION SITES <br /> JB MEDICAL.WASTE FACR nT ❑OTHER(PuEAsac SPaawy) <br /> WELL AND SEPTIC PERNT RECORDS ARE AVAILABLE FOR.RI:M&W- MONDAY-PARLAY 6:00 AN4: - EXCLUDING HCKMAY3. <br /> 9. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(20914 136 or mail to the address <br /> Indicated above. Address ranges will not be accepted-for additional assistance with file addresses,contact <br /> the EHD.Applications received after 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application, The flies will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be Immediately available fbr review. A new <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 of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> Eater�a,ss.�a <br /> 117(190 <br />