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MODESTO ATC PAGE 01 <br /> 08/28/2002 16:53 20o9-2225 <br /> ..!'............ ..G <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVIC <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 704 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 AUG 2 9 2002 <br /> PUBLIC_ RECORDS RELEASE APPLICATION <br /> APPLICANT_ {UJ't, r ( `" )4 " ky L EN <br /> BUSINESSIAGENCY EFRMIT/S RVICES <br /> ADDRESS lf1-} Lo 1�c.�Mn ,�,(-e.,nr� , Sark CS to pe1•bS}d pl 753 f <br /> PHONE FACSIMILE Z'QR 5'-i - 7225— <br /> TENTATIVE'APPOINTMENT DATE 9 to\ 2 TIME f ��a <br /> (Plcaso eivo 7 to�ushle da s Momto of application submillal) <br /> CHECK BOX TO,EXPEDITE REQULST-$07.00 FGE STt SEO IN 7 BUSINESS DAYS <br /> SIGNATURE OF 4PPLICANT b/ e., r+ ^— DATE <br /> FILE ADDRESS THIS SIOC CND STAFF USE ONLY <br /> PROGRAM ELEMCNTS SEARCH <br /> I f 3 �Aa.�l Road sk�ctc•1-an I <br /> t(� 1i Qr..� S ,r�►h a,n <br /> 2 ZSa2 S, l 4✓ 9 0� <br /> 2'S S, ;vtrtesaK <br /> 9 O W, vJ OAA. 4' vL of t y rotor ft <br /> $`i9l <br /> a ENVIRONMENTAL HEALTH DIVISION FILES <br /> 1��/'�NOr RGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING A13ATEMENT ❑ SOLID WASTE FACILITY <br /> F7 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLC <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) Cl DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMIYTFF,,D FACILITY ❑ MOTEIIHOTEL ❑ PUMPER TRUCK/YARDICHCM TOILETS <br /> ❑ TAT7001BODY PdIRCING ❑ POOLJSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WAS'fI!FACILITY ❑ PUCLiC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ADOVE) <br /> 1. List up to ten addresses in the space above. Solect the type(s) of filos from the list above by chocking <br /> the appropriate box(cs). At least one file type MUST be selected. Fax to (209) 464-0139 or mail IO the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EMD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than tan (10) days after receipt 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 now <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 $67,00 deposit prior to review. <br /> 5. *TENTATIVE appointment datos must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO R_ EVIEW DATE <br /> 6N <br /> - -OT-14 CO <br />