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ATC <br /> 09/11/2002 16:07 209-579-2225 MODESTO —'PAGE 01 <br /> 1. <br /> • . � 9f' '� <br /> �IN COUNTYPUBLIC HEALTH SERVICES Ifl1CCVE�1 \ILP <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR . <br /> SEP 1 2 2002 STOCKTON CA 95202 SEP 12 2002 <br /> (209) 468-3420 <br /> ENT HEALTH PUBLIC RECORDS RELEASE APPLICATION ENVIRONMENT HEALTH <br /> PERMI <br /> APPLICANT O BUSINESSIAGENQQCY a Z <br /> ADDRESS I�� IQ . U V <br /> PHONE - FACSIMILE /1 <br /> TENTATIVE'APPOINTMENT DATE �h6/� TIME , 10:ty <br /> (Plcapc Vivo 7 to 10 bbusiness da Irol a o(ap kation pUEmlllal) <br /> CHOCK BOX TO,EXPEDITE REQUEST• 7.0M-f"- -OU ROC D fBUSINESS DAYS <br /> SIGNATURE OF AiPLICANT DATE 9 11 uL <br /> FILE ADDRESS THIS SIDE EHO STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> of in. 2rG �• <br /> IIliq S <br /> ck. n <br /> li 19 <br /> 00 c <br /> 13 F o <br /> w <br /> 0 bus <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> )Z-UNDERGROUND TANK tUST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> X OTHER CLEANUP SITE(NON•LOP) ' O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) O DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTqQFACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEMTOILETS <br /> ❑ TATTOO(BODY PHIACING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL wA5T9 FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses In the space above. Select the type(s) of flies from the list above by chackinq <br /> tfie appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail 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 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$07.00 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 /> r <br /> ONFIRMED APPOINTMENT DATE TIME <br /> ATE CONFIRMED PHONE FAX INITIALS <br /> EVIEWEO�+ YES NO REVIEW DATE <br />