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04/11/2005 09:08 209-5725 MODESTO ATC / � ' ,PAGE 02 <br />DATE RECENED (_'`/J EiHoyLOG NWBeR <br />SAN JOAQUIN COUNTY <br />74- ENVIRONMENTAL HEALTH DEPARTMENT <br />1 304 East Weber Avenue, 3d Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: W0§ -0(V`1":91'50 <br />PUBLIC RECORDS RELEASE APPLIC,�TI�C�N <br />6A d d I -W 69Htt Y <br />APPLICANT: J-, , Kuvsderf BUSINESSIA�V I_ AT41 <br />ADDRESS: _.. _III-} Lo•1c_Pal1.^ Ave .5,r,4C C <br />1 , _11.444, A CITH WE VA <br />V\v <br />PHONE (1): 2.05 - SI't - -2'1-4 I PHONE (2): ZMa-9*F FACSIMILE: da as; Rum <br />TENTATIVE' APPOINTMENT DATE:- <br />(PIesss slow 10 business days from data of application wbmlasi - •TenbfNe only •must be <br />CHECK BOX TO EXPEDITE REQUEST - $23.00 FEE (CASH OR CHECK ONLY) . REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE 4^ II^ os <br />UNIT DISTRIBUTION <br />0 Unit 1 O Unit 2 0 Unit 3 <br />O Unit 4 0 Unit 6 <br />Cl UnK 6 0 Other (e1ectronWistslmape) <br />Street 0 <br />FILE ADDRESS <br />street Name <br />C <br />END USE ONLY <br />1. IS15 <br />S. Feesl.e <br />�. <br />2. t9 <br />W. CtsW, <br />S"#b% <br />3, iVl <br />S. «o <br />i ek <br />3 <br />4. 2005 <br />rave <br />s <br />usr <br />" <br />S. 2d6i <br />sk is <br />7. <1 <br />Le. rs <br />i_1.5 <br />9. w 1 <br />jll <br />Al, � w <br />s <br />9. <br />r <br />10. <br />Specific Dab Range of Information Requested: From <br />to 1 <br />MILZ 1101 <br />.r rrrr u` - Y V7 <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES r�e ry IY�j <br />,-3 <br />ARiKMiCC <br />tINGEROROIINO TANK(UST) CLEANUP SITE (LOP) O HOUSIND ABATEMENT 0 SOUG WASTE FAC O;1 <br />OTHER CLEANuP SITE ".Lop) 0 F000 FAI; m 0 WASTE TRE <br />UNDERGROUND TANK (MONITORINGIREMOVAL) 0 Doo KENNEL M DAIRY <br />HAZARDOus WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br />TIERED PERNRTED FACILITY O MOTELRiOTEL 0 PUMPER TRUMIYARGICHEM TORE" <br />0 TAT OO/BooY Pa RcRG 0 POOLISPA O LAND Use APPLICATION SITES <br />0 MEOICALL WASTE FACILITY 0 OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PE rr RECORDS ARE AVAILAau FOR RENEW • MONDAYFRIOAY 8:00 AM-S:OOPM . ExCLIIOING HOUDAYS. <br />1. List up to ten addresses In the space above. Select the type(s) of files from the list above by checking the <br />appropriate box(es). At least one file type MUST be selected. Fax to (2091464-0138 or mall to the address <br />indicated above. Address ranges will not be accepted -for additional assistance with file addresses, contact <br />the END. Applications received after 3:00 pm will be processed the next business day. <br />2. The END will notify the applicant H any END files exist. An appointment for review will be confirmed <br />approximately ten (10) days after receipt of application. The files will be held for a maximum of five business <br />days for review. Appointments should be scheduled 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 file not returned in the same condition as released will be reorganized by END staff at the expense of the <br />applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br />END Mtli01 <br />W444 <br />