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09/11/2002 16:07 209-579-2225 MODESTO ATC PAGE 01 _ <br /> V <br /> IIN COUNTYPUBLIC HEALTH SERVICES � ID(�~(�(�I /JE,P <br /> RDECETI � ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> SEP 1 2 2002 STOCKrONCA95202 SEP 1 2 2002 <br /> (209) 466-3420 <br /> ENT HEALTH PUBLIC RECORDS RELEASE /APPLICATION ENVIRONMENT HEALTH <br /> PERMI 1 <br /> APPLICANT O too a <br /> BUSINESSIAGENCY A-T-C �. <br /> ADDRESS B vCA9 7r3 <br /> PHONE — FACSIMILE' [d <br /> TENTATIVE'APPOINTMENT 17ATL• h,f /1l�'^tv <br /> (Plcanc Vivo 7 tou10 burincsc da Irol c o41BU51NE <br /> Ication:ubmlttal) <br /> CHECK BOX TO,EXPEDITE REQUEST- 7.00 FZI QUkSTPROC• SED S DAYS <br /> SIGNATURE OF AiPLICANT DATE 9 II Cm, <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 5t. A <br /> f 5 <br /> n <br /> G <br /> Vll_�, 3XEIo <br /> O t;uS <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> -UNOCRGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING A13ATEMENT O SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON•LOP) ' O FOOD FACILITY O SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) O DOG KENNEL O DAIRY <br /> O HAZARDOUS WASTC GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITT D,FACILITY ❑ MOTEIJHQTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> O TATTO01BODY PWACING ❑ POOL/SPA ' ❑ LAND USE APPLICATION SITES <br /> O MEDICAL WAS'rr FACILITY O PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY A13OVE) <br /> 1. List up to ton addresses in the space above. Select the type(s) of files from the list above by checking <br /> tfie appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0130 or mail to the <br /> address indicated ao6ve. <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 bo immediately available for review. A now <br /> application may be Submitted When the file is available. <br /> 4. Any file not returnod in the same condition as releasod will be reorganized by EHD staff at the expense <br /> of the, applicant. Future file reviews by the same applicant may require a W.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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED. PHONE FAX INITIALS <br /> REVIEWED '.+ - YES NO REVIEW DATE <br /> ■n DO 14 OW)IW <br />