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05/03/2005 11:34 209-579-2f MODESTO ATC 0 PAGE 02 <br />DATE RECEIVED EHq LOG NUMBERSAN JOAQtJIN Cc�UNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, 34 Floor, Stockton,, CA 95202-2708 <br />Telephone; (209) 468-3420 Fax; (209) 464-0138 Web, www.sjgoy.org/ehd Zt351 <br />PUBLIC RECORDS RELEASE ,APPLICATION <br />APPLICANT: ��BUSINESWAGENCY: Ai::D- A <br />ADDRESS: ��1 1 �btj9�- SAL P i ntthlia 0M mfia= 1 <br />PHONE RHONE (2): FACSIMILE: <br />TENTATIVE- APPOINTMENT DATE: <br />(Please allow 10 business days from date of application submittal - "T0706W only - must be twfirmed) <br />CHECK SOX TO EXPE R E T $93.00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 SU31NNE�SS DAYS <br />SIGNATURE OF APPLICANT � ~ DATE <br />iY=2 <br />■Unit Ir <br />• s • , <br />NO' i! <br />• r <br />_ <br />®• ILAWZM�r <br />®■fi� <br />MCA�[1 �i <br />++A` I 'I, <br />ME <br />ME <br />--�, <br />Specific Date Range of Information Requested: From n'lST to -- <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNOERowuw TANK (UST) CLEANUP &m (LOP) 0 HouslNa ABATEww 'gLSWD WASTE FAaLITYNEHICLE <br />OTHER CLEANUP SITE (NON -LISP) ❑ FOOD FACRlIY 13 WASTE TME <br />IM UNIERInROUNDTAW (MOWTORINGfR€NIMAL) O DOG KENNET$ E3 DAIRY <br />F VARDOUS WASTE? CENMTOR ❑ CHICKEN RANCH Q WASTMATER TRENTfAENT PLANT <br />Jls'nemo PERwrTED FAcLrty a MOTELIHOTEL O PumPER TRucKNAKu!CHEM T®ILEFs <br />❑ TATTOOMODY FIEMNO O POOI.ISPA ❑ LANO UsE APPL",MN Sn"ES <br />19 MEDICAL WA3TC FACILITY ❑ OTHER (PLEA= SaECIFY) <br />WELL AND SEPTIC PERNBT RECORDS ARE AVAILABLE FOR REVIEW - MONoAy-,PmaAY 5:00 AM-5:00PIA - EXCLUDING HOMAYS. <br />1. List up to ten addresses in the space above, Select the type($) of files from this list above by checking th(s <br />appropriate box(es). At least one file type MUST be selected. Fax to (20,9 464-0135 or mail to the address <br />Indicated above. Address ranges will not be accepted - for additional assistance with file addresses, con, act <br />the EHD. Applications received after 3.00 pm will be processed the next business day. <br />2. The EHD will notify the applicant if any EHD files exist. An appoinungnt 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 reviews. Appointrnants should be scheduled accordingly. <br />3. A file that is actively being worked on by EHD staff may not be Immediately available for reviews. 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 EHIQ staff Vt the expe,se of the <br />aDDlicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br />EHD 0-42-06 <br />111496 <br />I <br />