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07/13/2005 09:06 209-579-9025 MODESTO ATC PAGE 02 <br /> DATE RECEIVED <br /> n ((�(� p/J � SAN JI)A.QIJIN COUNTY -./ EHO LOG NUMBI <br /> RECEN <br /> t( � ED ENvmoNmNTj►LBxALmDEPARTMENT <br /> 304 �j� <br /> 1 E Weber Ave 3n°Floor Stockton,CA 95205 0 <br /> JUL 13 M 468-3420 Fax: (209)4640138 Web:www.co.san-joaquincaus/elad 1. 97 <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE AP�'P` ACATION <br /> APPUCANT: O l BU�I!ES]AGENCY: LEC Q 1 <br /> ADDRESS: I IG� —T erg �� 2&' �/�j Sir Q I <br /> PHONE: v / -"1 ' �.Z�- FACS MILE:� <br /> TENTATIVE`APPOINTMENT DATE:_ 7-O— 0 15— q C rV e <br /> (Please allow 10 buslnaa:i days 'tom date of allplteatlan aubMIHX) <br /> t <br /> ® CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REC UEST 2ROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1157 G <br /> saes [IUnit 1 D� I <br /> s. eves 1 <br /> 4. ❑ Unit 2cit 1�2, <br /> s. <br /> e. Unit 3 <br /> I, sa.a <br /> e, eves a Unit 4 <br /> v. <br /> o. ay.e [❑ Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES r <br /> P UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOMING ABATEMENT ❑ SOLID WASTE FACILITY <br /> t!-'OTHER CLEANUP SITE(NON-IAP) ❑ FO)D FA(:ILITY ❑ SOLID WASTE VEHICLE <br /> 92r'UNDERGROUND TANK(MONITORINGtRFMOVAL) Q DO.KEN VEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CH CKEN RANCH ❑ PKO TREATMENT PLANT <br /> Q. TIERED PERMITTED FACILITY ❑ MC rELMI)TEL ❑ PUMPER T'RUCK/YARDICHEMM TOILETS <br /> ❑ TATTOOMODY PIERCING ❑ PO)L/SPI, ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTI IER(P LEASE SPECIFY) <br /> 1. List Up to ten addresses in the space abo w. S elect the type(:)of flies from the list aboys by checking <br /> the appropriate box(es). At least one file'ype MUST be selected. Fax to (209)464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD witP notify the applicant If any EHD ill as exist. An appointment for review will be confirmed <br /> approximately five business days but no later t Tan ten (10) days after receipt of application. The file <br /> accordingly. 504 <br /> will be held for a maximum of five buainel s days for review. Appointments should be scheduled <br /> 3. A file that Is actively being worked on by I:HD staff may not be Immediately available for ravlaw. A new Q <br /> application may he submitted when the III a Is a.eallable. <br /> 4. Any file not returned In the same Conditio I as raleased will be reorganlFed by EHD staff at the expense <br /> Of the applicant. Future file reviews by the I same applicant may require a $93.00 deposit prior to review <br /> 5. "TENTATIVE appointment dates must be c onfinned with EHD staff. <br /> 6, Appiteations received after 3:00 pm will bl processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED »- YES NO REVIEW DATE <br /> �- <br /> evmos - <br />