Laserfiche WebLink
11 / 10 / 2003 16 : 20 209-579-2225 MODESTO ATC <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVIC 9S <br /> NOV 1 0 2003 ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> 1 = NVIRONMENT HEALTH STOCKTON CA 95202 <br />+ PERt141USERVICES (209) 460-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT IJ mw Q `I\ Plze \ h DUSINES5IAGENCY XT <br /> ADDRESS I Lou u�N4 e , So .'k D rtQnlir4� r,4 <br /> I ( ( � � - - <br /> I PHONE z `�— "t-Z-Zt FACSIIIMIILE• <br /> TENTATIVE" APPOINTMCNTOATE II -fl �} _ TIME O 1 .3d <br /> (Please give T la 10 hu:in ss Uayx from d�lc al SPPlicakian .ubMiltal) <br /> ❑ CHECK BOX TO,EXPEDITE REQUEST - 507 .00 FEEIj RCQUEST PROCESSED IN J BUSINESS DAYS �\ • 1 <br /> SIGNATURE OF APPLICANT �� ^ � �-F � DATE f t / /AIA <br /> FILE ADDRL• SS THIS SIDE CHO STAFF USE ONLY , <br /> PROGRAM ELEMENTS SEARCH <br /> dZ aLt <br /> 1 � �' t OV'r �0 LK L - <br /> to to t t 1o` Siatlt <br /> lot 2, 40 5 . ',.a 1'OU� S{v'+I' FTt✓u-M C.4 T <br /> %00 4L.d Kplba siof.K <br /> a5a on'f LY. `I C a <br /> ? ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ SOLID WASTE FACILITY <br /> Dt� UNOCRGROUND TANK (UST) CLEANUP SITE CLOP) ❑ HOUSING AeATEMBNY 0SOLID WASTE VEHICLC <br /> 0 OTHER CLEANUP SITE (NON•LOP) ❑ FOOD FACILITY <br /> C UNDERGROUND TANK (MONITORINGIRCMOVAL) 0 000 KENNEL 0 DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTgO FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCKIYARDICHCM TOILETS <br /> 0 TATTOOIBOOY PHIRCING 0 POOLISPA ` 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WAST 11 FACILITY O PUBLIC WATER SYS7CM ❑ OTHER (PLEASE SPECIFY ADOVE) <br /> 1 , List up to ten addresses in the space above, Select the type(s) of files from the list above by chocking <br /> ttie appropriate box(es) , At (cast one file type MUST be selected. Fix to (209) 464-0138 or mail to the <br /> addrass �indicated above . <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 now <br /> application may be submitted when the file is available. <br /> 4 . Any file not returned in t)he same condition as reteasod will be reorganized by EHD staff at the expense <br /> of the applicant, Futuro file reviews by the same applicant may require a $ 07.00 deposit prior to rCAOW, <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 APPOINTMENTDATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED �. YES - NO REVIEW nATF <br />