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_11/10/2003 16:20 209-579-2925 MODESTO ATC PAGE 01 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES 1 <br /> NOV ] 0 2003 ENVIRONMENTAL HEALTH DIVISION <br /> ENVIRONMENT HEALTH 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCICTON CA 95202 <br /> (0(7 -1'-- <br /> PERMIT/SERVICES (209) 466-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT rp-w 14^ M1Q-, <br /> OUS►Nt:55/AGENCY f'F <br /> ADDRESS L.OAt- 0`.M A.Jt, 5.,A-r- MatLS t{-.4 q,4 <br /> PHONE Z`Q1 5� —'Z.ZZt FACSIMILL _- Z 10 �"- <br /> TENTATIVE-APPOINTMENT DATL t•r (� ity� TIME C, <br /> (PlcJ:c give T to 10 bunmos1 tlay.from cjT. Or Spplicalion sub�+lillal) <br /> ❑ • <br /> GHECIC BOX TO,CXPEDITE" <br /> REQUEST-507.00 FCL r REQUEST PROCESSED IN 3 BUSINESS DAYS %A L4 <br /> l <br /> SiGNATURE OF APPLICANT �/�� V�-_ro�'"� DATE II/oz, � ^ <br /> FIL.[ADDRE=SS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SCARCH <br /> zoo s . EL r�d4 s � Fr-c•��+ Ca S <br /> oQ c..� 0.d scK -� -- <br /> 054Z) <br /> C <br /> �/ ENVIRONMENTAL HEALTH DIVISION FILES <br /> V� UNDCr(GROUND TANK(UST) CLEANUP SITE(LOP) O HOUSING ABATEMENT <br /> C OTHER CLEANUP SITE(NON•LOP) El FOOD <br /> FOOD FACILITY 501-11)WASTE r-ACILITY <br /> C UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 0 SOLID WASTE VEHICLE <br /> ❑ HAZARDOUS VVASTZ GENERATOR ❑ DAIRY <br /> ❑ TIERED PERMITTgD FACILITY p CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TATT001300Y PHIRCING ❑ f4OTELIHOTEL ❑ PUMPER TRUCKlYARD/CHCM TOILETS <br /> ❑ Mr-DICAL wA5'rlc FACILITY ❑ POOUSPA - ❑ LAND USE APPLICATION SrrL•5 <br /> Q PUt]LIC WATER SYSTLM CD OTHER(PLCASC SPECIFY ADOVE) <br /> 1 List up to ten addresses in the space above. Select the types) of files from the list above by chocking <br /> the 4pprdpriate box(es). At least one file type MUST be selected. Fax to (209) 464-01mail to the <br /> address indic�tcd above. <br /> 2 EHD will 3f3ornotify the applicant if any END files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (40) days after receipt of application. The files <br /> will be held fora maximum of five business days for review. Appointments should be scheduled . <br /> accordin0ly. <br /> 3- A file that is actively b6n0 worked on b <br /> application ma be y EHD staff may not be immediately available for review. Anew <br /> 4 Any file nvt antcrned submitted <br /> condwhen itiole is available. <br /> n as re CaSOd will be reorganized b <br /> of the applicant, Future file reviews by the same applicant may require a ;a7 00 dDpotsitarior o rcylo:e <br /> 5. "TE=NTATIVE appointment dates must be confirmed with END staff. <br /> 6. prior to revloW. <br /> Applications received after 3;00 Pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE <br /> TIME <br /> DATE CONFIRMED <br /> PHONE FAX INITIALS <br /> F2EVlEWED YES <br /> u,. NO REV►.w ncr� <br />