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11/10/2000 12:42 209-5725 MODESTO ATC • PAGE 02 <br /> TQ 5792225 P.@:c <br /> r FROri rvrnen <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> NOV 1 2 00 ENVIRONMENTAL HEALTH DIVISION �., A5" <br /> 304 EAST E8E <br /> W R AVENUE,THIRD FLOOR <br /> CKTON CA 95202 <br /> ENVIRONMENT HEALTH STO(zea)488-3420 <br /> PERMIT/SER ES PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESS/AGPNCY s V GIS <br /> Ap4UT �C <br /> 1a <br /> 'L-Z-1 <br /> 1 FAC <br /> SIMILE <br /> TIME <br /> ,., N IVF:"APPOMIN1ENT DATE outiOrt submittal) — <br /> Ipl%2m give 7 to 10 businens days ham 4816 of app <br /> JHECK BOX TO EXPEOITE REQUEST-SM-00 FE -REQUEST P OCESSED IN 3 BUSINESS DAYS Q <br /> DATE <br /> SIGNATURE OF APPLICANT W � ✓ " <br /> FILE ADDRESS <br /> au ML <br /> &A - <br /> LIt w. c „��• vJay, $ cl�lo� 3 2 u <br /> o- _ <br /> I� aAA^ <br /> t�I�.Li s��l✓�,, �at� >K, t s IZ,LK+o .�`��-i� � <br /> tS c>J t_r+ Ctr.+ar'' W a..t, 51�,1c.la.-, .�5•z� 2r`- �., <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP$ITE(LOP) ❑ HOUSIYC ABATEMENT O SOL10 WA5TE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) d FOOO FACILITY O SOLID WA3TE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL 0 DAIRY <br /> O HAZARDOUS WA&TL GENERATOR a CHICKEN RANCH O PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY O MOTEUNOTEL O PUMPER TRUCKIYARDICHEM TOILET$ <br /> ❑ TATTOCYBODY PFIRCING ❑ POOL13PA O LAND URE APPUCATiON SITES <br /> * MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to tan addresses In the sp*ce above. Select the type(*) of tiles from the list above by Checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(29;) 464.4138 Qr mail to the <br /> address Indicated atMvq, <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 tan (10)days after receipt of application. The files <br /> will be held 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 it'nmediateiy available for review. A new <br /> application may be swbmltted 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 $78.00 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 /> 1 <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Fh 44 4 41i0SA, <br /> TOTAL P.22 <br />