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12/,16/2003 17:54 20` ~79-2225 MODESTO ATC PAGE 02 <br /> SAN JOAQUIN COUNTV%00" tnu wu Nunnt <br /> --- _';i-`•,i;+_—,' ;iENVIRONMENTAL$FACTS DEPARTMNT <br /> 364 E Weber Ave 3'4 Floor Stockton, CA 95205 f ` <br /> ((209)468-•3420 Fair: (209)4640138 Web:www.co.san joaquin.ca.us/ehd <br /> UEi� 20Q; <br /> J ; 0 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPI-jdANTt�1 Q 1 1 _ BUSMESSIA�GENCY: TCASSOCJ14�esG <br /> ADDRESS/: 112 -7 q� dn@- G I YY� � i�c- �8 / <br /> PHONE: imayv <br /> TENTATIVE'APPOINTMENT DATE: I q �� T1rna: <br /> (Please aifow 10�nwm days i m bot pp tion submWal) <br /> C3 CHECK BOX TO EXPEDITE REQUEST•$93.00 FEE-REQUEST PROCESSED IN s BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Dapwtmont use Only <br /> FILE ADDRESS UR <br /> 1. atr..t AJ6 Unit 1 <br /> Z <br /> s d L 3 U ❑ Unit !�r <br /> //-- <br /> tit <br /> 4. gnat } Y <br /> r kUnit 3 l 1 <br /> e. sua.t <br /> a <br /> -7 a 4 <br /> a. sa..t �- } <br /> a aa.a 5 <br /> StLa <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> AN <br /> DERGOUND YANK(U$ )CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT M SOLID WASTE FACILITY <br /> ITER CLEANUPSITE(NON-LOP) ❑ FOOD FACILITY E3 SOLID WASTE VEHICLE <br /> DERGROUND TANK(MONiTORINGIREMOVAL) ❑ DOG KENNEL O DAIRY <br /> R'�KARDOUS WASTE GENERATOR C1 CHICKEN RANCH 13 PTREATMENT PLANT <br /> ❑ MOTEL/HOTE1. � PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY Q LAND USE APPLICATION SITE$ <br /> 13TATrOOlBODY PIERCING Q POOUSPA <br /> ❑ MEDICAL WASTE FACILITY d OTHER(PLEASE SPECIFY) - <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above ry checklni <br /> the appropriate box(es). At least one file type MUST be selected. F.I.t9 !3091464-0138 or mall to the <br /> address 101012A ah0e. <br /> 2. EHD will notify the applicant If any EHD flies 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 maxlmurn 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 no <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 EMU staff at the expens <br /> of the applicant Future file reviews by the same applicant may require a$93.00 deposit prior to reviel <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 8. Applications received after 3:00 pm will be processed the next business day. <br /> TIME <br /> CONFIRMED AI?POINTM&T, :PATE <br /> DATE CONFIl7MEl3 'PHONE FAX 1�ITiA�." <br /> —' <br /> REVIEW DATE. <br /> REVIEWED � ;:� _.,- ��YES NO .;.. <br /> uaaooa <br />