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_y 04/24/2006 10: 05 209-57?k,&225 MODESTO ATG PAGE 02 <br /> EHG,LOG NUMBER rM l} EDD SAN JOAQUIN COUN YENVIRONMENTAL HEALTH DEPARTMENT 234350 <br /> APR 2 4 2006 304 East Weber Avenue,3r'Floor, Stockton,CA 95202-2708 <br /> Telephone: (2()g)468-3420 Fax: (209)464-0138 Web: vE7ww,sJ90v_0zg/ehe1 <br /> E fi�T IiEA'�TFI <br /> p RMIT,�SEFiV4GES FYTBLIC RECORDS RELEASE APPLICA'HON ,.® <br /> BUSINESSIAGENCY <br /> APPLICANT: <br /> : <br /> A1Qr1Ri S5: U1 <br /> PHaNE( ): FA�StIMILE: j <br /> IPFIONE(1): ' <br /> TENTATIVE"APPOINTMENT DATE: noir'_ .L w• Tlt.4s: <br /> OINT <br /> (plalwe allow 10 business days from date of spp1imuon submittal-'Tang only-must be rgnfln3lod) <br /> l CHGG►':BOX Td EXPEnM REQUES -#93.00 FEE(CASH OR CHECK ONLY)-ReQUEST PROCESSED(N 3 SU84NTSS DAY$ <br /> sI NATEIf* OF APPLICANTr DA1'E - ., 2.�- --.- <br /> Q Unit 1 ❑ Unit 2 Unit 3 Unit 4 ❑Unit 3 Unit 8 ❑ Other(elsc6ronlclllatalmaps) <br /> UNrf DISTR1eILr <br /> FILE ADDRESS EHO USE ONLY <br /> 9traat#r Street Name city w <br /> 3. <br /> ` 4 <br /> jo <br /> 1A, <br /> Spsclftc Wite lttfnge of Information Requested:From to �— <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> $UPjnPP RouNw TANK(UST)CLEANUP SME(LOP) Q Houma ABATEMmT JQ SOLO WASTE rF CRj1rYlifEl lCLE <br /> �j OTWR CLAANUP SITE(NOW-LOP) 0 FOOD FAcil rrY C1 YYA3TE TkE <br /> LINE?EP W44UND TANK(MGWTGR1% 1REM'DVAL) Q DoG KENNEL ®DAmy <br /> WAZARDWS WASTE GENERATOK 0 CKcKrw RANCH ❑VVA$TEMVITER TREATAIRkT PUNT <br /> 0 Timm PERMRTM FACILITY Q MQTELMO11;L. ❑Pt)rAPERTRUc,dYARDICHEM To.LL-,S <br /> E)TATTOOIDODY PEERCING M POOL/SPA 0 LANC Use AppucATI w SITE.4 <br /> I eurAL WASTE FACILITY C OTHER(PLEASE SPEM" - --� ----- <br /> WEE_L AND SEPI is PERM RECORDS ARE AVAILA&Z FOR REMW - 11AOHVAY-rEanAY 8:00 A1M-6:44PM - Excuu iia HOLIDIItlo_ <br /> 1. List up to tan addresses In the$ghee ailova. Select the type(s)of files from the last abova by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax -0138 or,mail tQAftt%ddresf <br /> in-dlotpdabovs. Address rangers will not be accepted-for additional ass iaiancewitti ille addretsses, CfinUct <br /> the EHD,AppllGations rvicelved after 3;40 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHO files exist. An appointment for review will tv confirmod <br /> approximately tar!(10)days aftsr receipt of application. The files will be held for a maximum of five busIr-11M <br /> days for review. Appointment$should be scheduled a tcordingly. <br /> 3. A,file that Is.actrvely being wormed on by EHD staff may not be immediately available i1or review. A now <br /> application may be subrmltted when tete file Is available. <br /> 4. Any fila not returned in the same condition as reloased will be reorganized by EHD stiff at the expanss ol'the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> I _ <br /> 1. .. <br /> ENA 494240# <br /> 11th <br />