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0gl03/, 0 "3� $ 209-579-2225 MODESTO ATC _PAGE 01 <br /> I EmU LOG NUMBER <br /> - SAN JOAQUIN COUNTY <br /> SEP 0 4 2003 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EAST.WEBER AVENUE,THIRD FLOOR <br /> ::N`J;Fi0P4MENT HEALTH STOCKTON CA 95202 <br /> �'FRf%4►.TiSERV]CES �. (zas)a8s�42a <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 00,1I ��'" BU8INESSIAGENCY A L 1 <br /> ADDRESS <br /> PHONE <br /> ;ZtiL' FACSIMILE__ <br /> cn <br /> TENTATIVE"APPOINTMENT DATE TIME 04 <br /> (Please give.?to 10 bualnwm days from data of application submittal). • J�" <br /> ,CHECK SOXTO EXPEDITE REQUEST-$89.00 UE-REQUf BT PROCESSED IN 3 BUSINESS DAYS" f ���� <br /> � � <br /> U . <br /> [ <br /> SIGNATURE OF APPLICANT DATE � 31 43 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> z35 - <br /> 7-Lt <br /> all- a <br /> a <br /> JLM <br /> ?X41 1.1p.I r�v-L S' n <br /> J .. -- ENVIRONMENTAL HEALTH 01-VISION FILES <br /> Is(UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) t7 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> If ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOCS KENNEL ❑ DAIRY % <br /> ❑ HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH (O PKG TREATMENT PLANT <br /> CI TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTO01BODY,PEIRCING ❑ POOLISP,A.. ❑ LAND USE APPLICATION SITES <br />'i ❑ MEDICAL WASTE FACILITY' ❑ OTHER(PLEASE$PECIrn <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file typo MUST be selected.-Fax to(gQ9.) 464-0138 or ma)I to the <br /> addres.S lndicat__@"4Qye. <br /> .2. EHD will notify the applicant If any EHD flies exist. An appolntment for review will be confirmed <br /> approximately five business days but no iater,'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 new <br /> application may be submitted when the file is avallable. <br /> 4. Any lite not returned in the slime condition as:releaaed will be reorganized by EHD staff at the expertise <br /> of the applicant. Future file reviews <br /> I. b the same applicant may requireuire a$89.00 deposit <br /> prior to review." <br /> 5. <br /> TENTATIVE <br /> appointment dates must be confirmed with EHD staff. <br /> 6. Appl(cattons received after 3:00 pm will be processed the"next business day. <br /> ?1 'tiPiRhCtlltkl Tl7li'CiA*,'I'E <br /> :limit i r <br /> F t�,*T111iiv PHCNE" F )iVli&tis <br /> REVS**1 �l 1N.E$ �ro fz�t� i <br /> N. N've <br /> 1i. atev�ow Li - 'Li <br /> 1,03. clm q-.L,.{:a 777 / GWr <br />