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09/11/2002 16:07 209-579-2225 MODESTO ATC PAGE 01 _ <br /> V � <br /> EQ((�II\ c� CJJ S ENVIRONMENTALINCO TYPUBLIC HEALTHSERVICES ��9Em""(�rlWE[—:,D <br /> , `�� ' HEALTH DIVISION L `�JL�I V L_ <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> SEP 1 2 2002 STOCKTON CA 95202 SEP 1 2 2002 <br /> (209) 468-3420 <br /> ENT FIEATH PUBLIC RECORDS RELEASE APPLICATION ENVIRONMENT HEALTH <br /> PEW <br /> APPLICANT BUSINESS/AGENCY <br /> ADDRESS t� "�v 9 T3 <br /> PHONE — FACSIMILE <br /> TENTATIVE-APPOINTMENT DATI: � � TIME <br /> (Plcattc pivn 7 to 10 business da Iroi c of ap Ication:ubmiltal) <br /> CHECK BOX TO,EXPEDITE REQUEST- 7.0, QU ROC S l J B 51N S DAYS <br /> u �;; <br /> SIGNATURE OF AiPI_ICANT DATE 9 ), trt— <br /> FILE ADDRESS THI SIDE THD STAFF USE ONLY <br /> PROGRAM ELEMCNTS SEARCH <br /> 1,44 <br /> 5 c <br /> C� 4 <br /> 13 E o <br /> tn, a <br /> O Vu5 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> )9-VNDERGROVND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ,,OTHER CLEANUP SITE(NON,LOP) 13 FOOD FACILITY O SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) O DOG KENNEL O DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> Cl TIERED PERMITTD FACIUTY ❑ MOTEIJH'bTEL ❑ PUMPER TRUCKJYARDJCHEM TOILETS <br /> O TATTO0I8ODY PJACING ❑ POOUSPA ❑ LAND USE APPUCATION SITES <br /> O MEDICAL 1IVA5'r11- FACILITY O PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOVE) <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 type MUST be selected. Fax to (209) 464-0138 or mail to the <br /> address indicated above. <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 maxlinum 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 new <br /> application may be submitted when the file is availablo. <br /> 4. Any file not returned in the same condition as releasod will be reorganlzod by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $87.00 deposit prior to review. <br /> 5. *TENTATIVE appointment datps 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 09 14 MO _ <br />