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5 <br />09/19/2002 16:03 209-57 225 MODESTO ATC PAGE 01 <br />V SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES- <br />.;o <br />v <br />0 ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR (] <br />STOCKTON CA 05202 <br />(209) 460-3420 <br />PUBLIC RECORDS RELEASE APPLICATION SE, 1.9 2002 <br />APPLICANT� �/ AIPE BUS1N[SSIAGENCY /4% �SSe r,�1 L►IR()NMENT HEALTH <br />VICES <br />ADDRESS /// 7 4oAJ& PA1_k%�4•vs SL417 R t.3 , /'%!»S'T0. � 9`�5 ITT <br />/ , <br />PHONE -gyp �a / f FACSIMILE ` zb9) 579- <br />TENTATIVE" <br />79`TENTATIVE" APPOINTMENT QATL le! Tl Q Z_ TIME le) a00 'A <br />(PIMC! Dive 7 to 10 bu.in * days Ire ale O` appl' wlon submittdl) t7= <br />Ar 0 <br />L.J U T - RO D IN 13USINF-SS DAYS <br />CHECK BOX TO,EXPEDRE REQ [:5 �riQ -E - E Ulr_ " <br />SIGNATURE OF APPLICANT <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT O SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) O FOOD FACILITY O SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORINGIREMOVAL) 0 DOG KENNEL O DAIRY <br />HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />0 TIERED PERMITTED FACILITY O P40TELIHOTEL O PUMPER TRVCKlYARDICHCM TOI1.E•r8 <br />O TATTOO18ODY P14IRCING ❑ POOUSPA Q LAND V5E APPLICATION SITES <br />O MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM O OTHER (PLEASE SPECIFY ABOVE) r <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br />tlic appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0136 or mail to the <br />address indicated above. <br />2. EHD will notify the applicant if any END files 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 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 END staff may not be immediately available for review. A new <br />application may be submitted when the file is available. <br />4. Any flit 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 $07.00 deposit prior to review. <br />5. "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 <br />REVIEWED ,I YES NO REVIEW DATE <br />INITIALS <br />