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\v <br />V <br />j V <br />0 <br />Q9/13(�0�� 2209-5-k-2225 MODESTO ATC PAGE 01 <br />E"D LOG NUMBERSAN JOAQUIN COUNTY . <br />SEP 0 4 2003 ENVIRONMENTAL HEALTH DEPARTMENT <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />'-MIRUNMENT HEALTF; STOCKTON CA 95202 <br />pF MIT%SERVICES (209) 468-3420 <br />PUBLIC <br />- RECORDS RELEASE APPLICATION <br />APPLICANT 41W ', �" BUSINESSIAGENCY <br />ADDRESS M-4- UNt4 �e. C��...,, ".4.,••t- S.),'kc- 13 <br />PHONE _" -L•Z•tt FACSIMILE Sl -q <br />TENTATIVE* APPOINTMENT. DATE —jj!ffj`31 I Y14::j3 TIME . (3c? cc-, <br />(Plans* give 7 to 10 business days from date of application submittal) • <br />Z�� <br />CHECK BOX TO EXPEDITE REQUEST� -;99.00 F E – REQUEST PROCESSED IN 3 8USiNESS-DAYS 1 11� �) <br />SIGNATURE OF APPLICANT J%�'�'" �� `A - DATE R 31/Q:5 <br />OFF e v <br />NVIF2QNMENTAL HEALTH DIVISION FILE <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY <br />❑ OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOUL) WASTE VEHICLE <br />O UNDERGROUND TANK (MONITORING/REMOVAL) CO DOG KENNEL ❑ DAIRY <br />❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />Cl TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br />❑ TATTOO/BODY PEIRCING ❑ POOIJSPA ❑ 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(s) of files from the list above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or MALI t2 the <br />address indicated move. <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 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 EHD staff may not be Immediately available for 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 <br />of the applicant, Future file reviews by the same applicant may require a $89.00 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 />. - IMPOINThil�bi( i.04T 'G1i l <br />QBE . W PHCOX ..- �NIi Y .8 <br />R@:V6 V0 YEA NO <br />MO 4542-005 <br />3lZSf2507 �j - +0.3. 6 -'lm q -E( -o /9lu6,_,/ t <br />P% -7x. - tcd,�w <br />THIS SIDE : <br />PROGRAM ELEMENTS SEARCH <br />oil <br />M.`ice'" <br />_ r■Wrrnr <br />OFF e v <br />NVIF2QNMENTAL HEALTH DIVISION FILE <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY <br />❑ OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOUL) WASTE VEHICLE <br />O UNDERGROUND TANK (MONITORING/REMOVAL) CO DOG KENNEL ❑ DAIRY <br />❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />Cl TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br />❑ TATTOO/BODY PEIRCING ❑ POOIJSPA ❑ 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(s) of files from the list above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or MALI t2 the <br />address indicated move. <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 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 EHD staff may not be Immediately available for 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 <br />of the applicant, Future file reviews by the same applicant may require a $89.00 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 />. - IMPOINThil�bi( i.04T 'G1i l <br />QBE . W PHCOX ..- �NIi Y .8 <br />R@:V6 V0 YEA NO <br />MO 4542-005 <br />3lZSf2507 �j - +0.3. 6 -'lm q -E( -o /9lu6,_,/ t <br />P% -7x. - tcd,�w <br />