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i <br /> 05/ 14/ 2003 10 : 01 209- 579-777.5 MODESTO ATC PAGE 01 <br /> oAot !eeeerRo - <br /> r.Motoo MUIrlaes <br /> SAN JOAQUIN COUNTY <br /> MAY 1. 4 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTpN CA 95202 / I <br /> (209) 4894420 <br /> PUBLIC RECORDS RELEASE APPLICiVrIO N - <br /> APPLICANT Dream aV% M%#'^ BUSINESWAGENCY Arc <br /> ADDRESS IWt (, osa PnAH 9Ave.,nrC S , %% 4jt .B . . A'TA' Ls (•o <br /> PHONE Z%t�o9 5'+q ^ ZZZ 1 IFACSIMILi? Z+M 'r <br /> TENTATIVE* APPOINTvENTDATE Sf TIME �roob ..-. -- 31 <br /> TIOM gale T to 10 buzftt a dye from date a rapplI affm NWMIft) '�/M'' q J <br /> CHECK SOX TO EXPEDITE REQUEST - M.00 F `9g REQUEST PROCESSED IN 3 BUSINESS DAYS �/M , r� <br /> SIGNATURE: OF APPLICANT b Al \/ O� /+�� D ATE .5 j1 L 1 � "3 <br /> FILE ADDRESS -- THIS $IDI:EHG STAFF USE ONLY <br /> PROGRAMA ELEMENTS SEARCII <br /> 1 �- S�-�1-\n Sr.-c �•,o ',� ,4Ne . S4oCKlo�. L, �?7_ <br /> 'L'SS3 T"o��-c, '�•coa 1" rut-) �, _�_ <br /> 'Z'343 �Y _ 132. 4r.r. ► \�S L arab _ _ <br /> sl c'A� t cWb viva , 34. ocyk- <br /> y Mac do I L &+VY .i LG' ,in Yap — <br /> I ; � eFa0Ir -- - <br /> z.14 �_ c} raorc. s4-r+u�i., o -.i2a • ,� � -- — <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 3s. UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ ROUSInG A13ATEMENT - ❑ SOLID Mf45TE FACILITY <br /> ❑ OTHER CLEANUP SITE (NON=LOP) 0 FOOD FACILITY ❑ $OLIO w.4STE VEHICLE <br /> ❑ UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOD KNNNEL ❑ DAII9Y - I - - . _ <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICIQiN RANCH ❑ P01 TRr ATMENIT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑ MOTELHOTEL ❑ PUMPER TRUCIVYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLMPA ❑ IANID USE APPLICATION ISITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY)_— . --..` <br /> 1 . List up to ton addresses in the space above. Select the type(z) of filen from @ho lint above by checking <br /> the appropriatebox(es). At least one file type MUST be selected. fw,),Q,� )__44;9138 or mall to khj <br /> a Icated above. <br /> 2. EMD will notify the applicant If any EHD files exist, An appointment for revs rn will be confirmed <br /> approximately five bUSlness days but no later than tan (10) days after reaelpl. of application. The flies <br /> will be held for a maximum of five business days for review. Appointments nhoull:l bo Ichaduled <br /> accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be immedlatoly Nval9able for review. A new <br /> application may be submitted when the file let available. <br /> 4. Any file not returned in the same condition as released will be reorgardzrad by EH[I staff at the expense <br /> of the applicant Future file reviews by the snore applicant may require a S8S .OD deposit prior to ruvlaw. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 9. Applications received after 3:00 pm will be processed the next bualnsea day. <br /> -COWIFMW APPOINTLI$NT DATE TI& <br /> DATE OONFIIWED PHONE FAX 0.11T 41 <br /> RE?t/ YES NO RUAI1 f illor <br /> EMU 4a-02.0a! s.—_=ma,���---• <br /> 72VSr01 <br />