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09/U1/2UU4 12:4/ 2UJ-579-2225 MODESTO ATC PAGE fel <br /> • EHD LOG NUMBS <br /> DATE RECEIVED SAN .IOAQUIN COUNTY <br /> L sh��� v D ENviRONn�ENYALHEA_LTHDEPAATNMNT <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 Iq <br /> SEP 0 1 2004 (209)468-3420 Fax: (209) 4w64-0138 Web: ww.co.san-joaquin.ca.us/ehd <br /> L IRI i`JI'v?ENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> ` I t <br /> APPLICANT: blew Vati A\ki" BUSINESSIAGENCY: <br /> AT� <br /> ADORES$: L,3 A , palwv A-,^° S.�ti-�. D Mo�•uslo <br /> a Z S7"9 - Zz2.( -L..'o1 S 3`-9 - LL-2-Y_ <br /> PHONE: Z FACSIMIL " <br /> I r{�y <br /> TENTATIVE"APPOINTMENT DATE: � � T1me: 090 <br /> (Please allow 19 business days from data of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-Ss3.00,FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ��^ /INDATE <br /> jJO • On`� L.�� Rt�+s r S` .S -K+eWh Lc�nLts+rxznt Deoartrront Use Only <br /> FILE ADDRESS UNR <br /> 3SaP mZ ,. so.. 5`t�0 o cc tc Vt�1..lt. sEOtK hUsf {AZ, �S C3 Unit <br /> z saeee 51^t 4Lt it <br /> 3 5�p a. su.e Co 4vti L v r L �C 7 $kit k V,' 9 Unit 2 ear,O <br /> 3`24 rn� ._ so-e« �r,tt tt t,.tvl S r✓e 'I� 5i 2 arl <br /> e, ae«e Lo l k. /•'eo.+� S4N-�1- S CK "1 g <br /> 3 S � •� e. 3". 7 �I rI..AL� CS d, , d MCI t1 <br /> 3 W. 6k% ., a Strotl[�on Uni <br /> S lk <br /> "5Z3� N, ITIfS�4- 4�- -, <br /> BN Ste' S CK C3 UnitS <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 'ar UNDERGROUND TANK(U"CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> t2 .OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> W UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> W HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> YI TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> 0 TATTOClBOOY PIERCING ❑ POOVSPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List Up to ten addresses In the space above. Select the type(s)of files from the list above by checkinE <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2a91 464-0138 or mall to the <br /> address Indlcsted above. <br /> 2. EHD will notify the applicant It 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 net <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 493.00 deposit prior to revlev <br /> S. '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 /> swaao. <br /> uenaas . <br />