Laserfiche WebLink
WJ/b1/217174 ,,12:4( 2U7 J-579-2225 - MODESTO ATC PAGE 01. <br /> DATE RECEIVED EHD LOO NUM13E <br /> { (,'r •�, SAN JOAQUIN COUNTY ' ...� <br /> `r 1 ; S ENVIRONMXNTAL HEALTH DEPARTMENT <br /> S E P O 1 2004 304 E Weber Ave aid Floor Stockton, CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca.US/ehd Iq 815 <br /> tv{Vi s,liVPvlcErNryT HEALTH PUBLIC RECONS RELEASE APPLICATION <br /> APPLICANT: O f,(_w Q oti H A4-— BUSINESSIAGE14CY: AT G <br /> ADDRESS: t1 L�A l, Q, MOOS4414? <br /> PHONE: S77- FACSIMIL : � s 7-1 - <br /> TENTATIVE*APPOINTMENT DA.E: L d�`t Tlrne: _ �Q <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-583.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT U t`�'^'�L lj`-' " 1 DATE <br /> k4p'j"'. Q r�k'7 Lit ISL SIS � S i S +A&o4-+�1� `'�� u1 i rKer j Department Use OnlY <br /> FILE ADDRESS UNir <br /> 35a'rn' m ,. sweet :5-i%30 a c t_ v tom.+-` S C K h u� AZ. >1X <br /> z sweet �I TI 4Lt l�. a.AVZ a $ c K H �- C] Unit 1 f <br /> Bret CQ Qo►y << v e�-� }' Unit 2 l <br /> e. aw.et Lo l k. /��4.� S�r�►-k• cftv Unit S C1t 3 <br /> a s�� V n str,et Z �-1 !;. ,.��� Ca O Nva <br /> -3 s a7 T 3 Ul. ON Un* <br /> 35a `'t, at" LtoO-t ctwS tk <br /> 35a�i eel $L� •5� S t K �► ❑ Units <br /> 3 S�7k sweet l Si t,Y i/r two M 5 � <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT (O SOLID WASTE FACILrrY <br /> 12 OTHER CLEANUP siTE(NON-LAP) Ci FOOD FACILITY C3 SOLID WASTE VEHICLE <br /> W UNDERGROUND TANK(MONITORINGIREMOVAL) 13 DOG KENNEL C3 DAIRY <br /> hr HAZARDOUS WASTE GENERATOR O CHICKEN RANCH O PKK TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTELMOTEL = PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> 7. List up to ten addresses in the space above. Select the type(s)of flies from the slat above by checking <br /> the appropriate box(es). At least one file type MUST be selected, FyX 14(Z09 4138 or mall to_thQ <br /> address indicated above: <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 flies <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 nei <br /> application may be submitted when the filo Is available. <br /> 4. Any file not returned In the same Condition as released will be reorganized by END staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review <br /> 5. *TENTATIVE appointment dates must be confirmed with END staff. <br /> 8. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRM ED P14ONE FAX' ` . ."'" °)NITIALS: <br /> REVIEWED YES NO REVIEW DATE <br /> ,.-ozaw <br /> u�naas <br />