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11/10/2000 12:42 209-57`25 MODESTO ATC • PAGE 02 <br /> 1 <br /> - 5792225 P2 <br /> FROM0 ..,.....� ..-n�. <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> NOV 10 ZOOO ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> ENVIRONMENT HEALTH STOCKTON CA 93202 <br /> PERMIT/SER ES (209)488.3420 <br /> ,�,^� ,_,.-, <br /> PUBLIC RECORDS RELEASE <br /> /APPLICATION <br /> A LI tT "�l'1�G.J' fiUSINESS/AGBNCY� v SV Git <br /> 3 t0 N <br /> FAusCtt(nSIMILE <br /> IVE APPOINTMENT DATE TIME <br /> (PhaselveT AF <br /> beVof <br /> — <br /> 4ata of 3QPticati*n submittal) <br /> CHECK BOX TO EXPEDITE REQUEST•S7tl.00 FE -REQUEST P OCESSED IN 3 BUSINESS DAYS <br /> C'F_ 1 1,( (P3 � <br /> l <br /> SIGNATURE OF APPLICANT LSI ��^ DATE <br /> FILE ADDRESS <br /> Z33. -2U It/L.L _ <br /> I Li-,r o Si �.J 34nLr1o�t 3�_� _ <br /> Kt <br /> 44I0 t1J• ( vVkr Wo.4 LKfv� ,�a1 1C� <br /> I`I tt`') Soa♦✓�n loth t S{yi.Kf-0s�y�,L; <br /> kA l' r W bete 2U RI� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) G HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> O UNDERGROUND TANK(MONITORINOIREMOVAQ ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE 04NERArOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMrrTED FACILITY O MOTEL/MOTEL ❑ PUMPER TRUCK/YARDICHEM TOILET$ <br /> ❑ TATTO(YRODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ton addresses In the space above. Select the type(*) of files from the list above by chocking <br /> the appropriate box(es). At least one ilk ty0e MUST be selected. Fax to(29914$4-0138 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 receipt of application. The files <br /> will be held for a maximum or five business days for review. Appointments should be scheduled <br /> accordingly. <br /> ;. 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 the is available. <br /> a. Any file not returned In the same condit;on 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 $78.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> S. Applications received after 3:00 pm will be processed the next business day. <br /> I <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIAL5 <br /> REVIEWED YES NO RBVfEW OATS <br /> \h 0♦ ♦ OtAfgy <br /> TOTAL P.02 <br />