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\ 08/29/2003 15:23 209-579-2225 <br />�{ TE RECEIVED <br />MODESTO ATC <br />DA SAN JOAQUI N CO <br />(0 �I LS �''/ I� E ONMENTAL ALT7d DEPARTMENT <br />U�] 304 E Weber Ave 3 Floor Stockton, CA 95205 <br />209 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd <br />AUG 2 9 2003 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APfiLF T/S�ukstc/ / aUstNEs9,AaENCY: fi rC Ap act®tpc J ..fit c <br />ADDRESS: 1117 /-cmc pp fwd Ave S", to .NCMod& � 7r36-( <br />-7 r <br />PHONE: sr'� ^' Elf- 2221 FACSIMILE• f�9" ��5.� <br />TENTATIVE* APPOINTMENT DATE: S-ejo /;z . eZ910.3 _ Time: 0"0 <br />(Please allow 10 business days from date of application submittal) <br />® CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE- REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANTxz�leDATE <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />N UNDERGROUND TANK (UST) CLEANUP SITE (LOP) o <br />Iq OTHER CLEANUP SITE (NON -LOP) L❑ <br />8 UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ <br />Of HAZARDOUS WASTE GENERATOR ❑ <br />O TIERED PERMITTED FACILITY ❑ <br />0 TATrOOIBODY PIERCING 0 <br />❑ MEDICAL WASTE FACILITY 0 <br />PAGE 01 <br />END LOG NUMBI <br />ME <br />Department Use Only <br />UNIT <br />® Unit 1 <br />❑ Unit 2 <br />Unit 3 <br />4 <br />❑ Unit 5 <br />2 20` <br />HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITY <br />FOOD FACILITY <br />0 SOLID WASTE VEHICLE <br />DOCS KENNEL <br />Q DAIRY <br />CHICKEN RANCH <br />❑ PKG TREATMENT PLANT <br />MOTELIHOTEL <br />13 PUMPER TRUCKIYARD/CHEM TOILETI; <br />POOLiSPA <br />M LAND USE APPLICATION SITES <br />OTHER (PLEASE SPECIFY) <br />rr <br />- -= orf <br />1l�MNI!'1AIY�1#C61/L"-19� <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />N UNDERGROUND TANK (UST) CLEANUP SITE (LOP) o <br />Iq OTHER CLEANUP SITE (NON -LOP) L❑ <br />8 UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ <br />Of HAZARDOUS WASTE GENERATOR ❑ <br />O TIERED PERMITTED FACILITY ❑ <br />0 TATrOOIBODY PIERCING 0 <br />❑ MEDICAL WASTE FACILITY 0 <br />PAGE 01 <br />END LOG NUMBI <br />ME <br />Department Use Only <br />UNIT <br />® Unit 1 <br />❑ Unit 2 <br />Unit 3 <br />4 <br />❑ Unit 5 <br />2 20` <br />HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITY <br />FOOD FACILITY <br />0 SOLID WASTE VEHICLE <br />DOCS KENNEL <br />Q DAIRY <br />CHICKEN RANCH <br />❑ PKG TREATMENT PLANT <br />MOTELIHOTEL <br />13 PUMPER TRUCKIYARD/CHEM TOILETI; <br />POOLiSPA <br />M LAND USE APPLICATION SITES <br />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 checkin <br />the appropriate box(es). At least one file type MUST be selected. Fax to (209) §§A:QJ38 or mail to the <br />address Indicatedgbove. <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 nt <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 expen: <br />of the applicant. f=uture file reviews by the same applicant may require a $93.00 deposit prior to revle <br />3. "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 ..-INITIALS <br />REVIEWED ,. YES NO REVIEW DATE <br />eHo e41 -02-M <br />WW003 <br />