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03/03/QA - 0@ 209-579-2225 MODESTO ATC PAGE 01 <br /> iMT�Rl�RI)(RO IiI \7 _. <br /> v I' SAN JOAQUIN COUNTY FNO IOe NUY3lR• <br /> SEP 0 4 2003 ENN'ONMENTAL HEALTH DEPARTMENT <br /> 304 EAST WESER AVENUE,THIRD FLOOR <br /> _.NV;R0NM1L:NT HEALTH STOCKTON CA 95202 I� <br /> pE M!T'SERViCES (209) 468-0420 <br /> PUBLIC RECORDS RELEASE APPLICATION Fiern <br /> APPLICANT "` BUSINESSIAGENCYLX22 <br /> II r� tt �� I <br /> ADDRESS (�t�- l..^`a lC. \�1.`�.�.. />.tl-2A,,-LrT <br /> � SJ. K- V M � <br /> ��pp <br /> PHONE�r-T " ZZ-T-� FACSIMILE S�l '-ZZ"Z.S— <br /> TENTATIVE'APPOINTMENT DATE n 4 '0'3 TIME 04 Qr:� <br /> (1-1.23•give T to 10 busina3a days from date of application submltt2l) • <br /> ^J� <br /> E CHECK BOX TO EXPEDITE REQUEST-288.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS O' I Z/ ) <br /> V J � <br /> SIGNATURE OF APPLICANT � � C� �Lr�— DATE R 31 'CZ3 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> z35 0 } <br /> -7-L(SD %LQa d <br /> Z.)-- S Gve nr Qoec/ 1.e. <br /> a ti o crJ, } CA— 14 '0 _ 1 <br /> �,/ NVIRONMENTAL HEALTH DIVISION FILE <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> Q UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL Cl PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses In the space above. Select the type(s) of flles from the []at above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mall to the <br /> address 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 recelpt of application. The files <br /> will be hold 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 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 EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$69.00 deposit prior to review. <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 /> r7WttaAPPOINTt*jFNIT DATE TI1Vl <br /> DkTE CONFIRMED <br /> PHONE. ►NlhiAlB <br /> REVi"WED YES NO REVf£Nk,@ALE <br /> uea:aw �) - -J7• �f'vM "mac(-CC. eti/JG ^✓7'L C(C r`c�� 61-62`3 '3 v 12(u 1 / O7, <br />