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08/ 16/ 2002 11 : 44 209-F79 -2225 MODESTO ATC PAGE 01 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES { <br /> ENVIRONMENTAL, HEALTH DIVISION <br /> r 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 463113420 <br /> PUBLIC( RECORDSRELEASE APPLICATION AUG 18 2002 <br /> APPLICANT CIL v4% �•1\ �..J DUSINE55/AGENCY AwIIA-Stnc \a�+c ENVIRON H <br /> ADDRESS MMI l_� .nL o.`V•n .J;vtnr � ICES <br /> � % LkI (A Y5 7S' I <br /> PHONE �.'09 `S �'} ^ -L"L`L 1 FACSIMILE Z�9 <br /> QB [ ?.- ;11.[ <br /> TENTATIVE' APPOINTMENT DATE 'o1. TIME moo <br /> (Plcasc Div Y 10 buMIA <br /> 11•o c of of/pj��I/J►a(ion :ubmiRal) <br /> 0 CHECK 80X TO,EXPEDITE REQUEST - $07.00F -oROD IN II�uSINEss DAYS <br /> I SIGNATURE OF APPLICANT f DATE <br /> FILE ADDRESS <br /> THIS 510E EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 1 $4 $ aW . Trot Ql.l . S1oaK}on o 6 7 <br /> Irk <br /> a4d Si+� t� +•c• + m o v <br /> tz \, tett dza M:ac ,a.ta� >t Ma�4aL <br /> `I � t+ 4l ' la.,aa 132 rAa1( S a <br /> SOC) (iJbS+- 11 S+ l`ee+, 1 ✓'DC m <br /> 1�V5 WtI CIAGr wad • <br /> L0 FMcat+ L1�yr4ar Wft 5(+ocK�On s <br /> Zt `t1 4% PIA <br /> i2tZ 1 } Eotti 1 4wt Z V S+aCIC(•o +i � <br /> go{ 61 tri- t_wn1� �a,n•Ic. L�¢!t 0 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ADATCMENT ❑ SOLID WASTE FACILITY <br />•i OTHER CLEANUP SITE (NON-LOP) El FOOD FACILITY ❑ <br /> Ij SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK (MONITORING/REMOVAL) LIDOG KENNEL ❑ <br /> DAIRY <br /> i ❑ HAZARDOUS WASTL• GENERATOR ❑ CHICKEN RANCH 4 pKG TREATMENT PLANT <br /> ❑ TIERCD PERMI FACILITY ❑ MO'rEUHOTEL_ ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PHIRCING ❑ POOLISPA <br />�i ❑ MEDICAL. WASTI FACILITY ❑ Pua4 ❑ LAND USC APPLICATION SITES <br /> PUBLIC WATER SYSTEM ❑ OTHCR (PLEASE SPECIFY ABOVE) <br /> 1 , List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> ttie appropriate box(es). At least file type MUST be se ected. Fax to 209 464-0138 or mail to the <br /> address indicated above �������•� <br /> 2• CHO 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 hFld for a maximum Of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3 . A file that is actively being worked an by EHD staff may not be Immediately available for review. A new <br /> i appllCation 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 /> j Of the applicant• Futuro file reviews by the Same applicant may require a $07.00 deposit prior to review, <br /> 5• 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> j 6• Applications received after 3:00 pm will be processed the next business day. <br /> i <br /> CONFIRMED APPOINTMENT DATE TIME <br /> jDATE CONFIRMED PHONE FAX <br /> INITIALS <br /> REVIEWED YES , <br /> III, 144 Loa NO REVIEW DATE <br />