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05/03/2006 11:34 209-579-9225 MODESTO ATC PAGE 02 -� <br /> L✓ <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN.ToAQIJIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3rd Floor,Stockton,CA 95202-2708'telephone; (209)468-34x0 Fax;(209)464-0138 Web:www.sjgov.org/ehdZ351 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:t Asa MWkL 13USINEWAGENCY: Amp s5t>r✓IA. Sr <br /> ADDREss: It 0 La t i gE- P"A LM�+Zarw CA <br /> PHONE(1): 1:09.0M,'� IT7 1 PHONE(2): FACSIMILE.' <br /> TENTATIVE''APPOINTMENT DATE: 5 Irl•CJFs Time: RAA- <br /> (Please allow 10 business days from doh of applleatlon submitlal-"rsrrhr6W only-must be confirmed) <br /> 0 CHECK BOX TO EXPE R E/ 193.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 SU31NESS DAYS <br /> SIGNATURE OF APPLICANT"ri o`. DATE <br /> UNIT DISTRIBUTION 13 Unit 1 In Unit 2 AUnIt 7 00 Unit 4 D Unk 5 Unk 6 0 Odd(eleatr IcAk <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 SVeat Name City <br /> 1. 7 1E. tas-r f.ePYA h <br /> 2. 1 O E. <br /> a <br /> OP <br /> t3. - <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Oate Range of Information Requeawl:From to <br /> ...ddd,,, ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IkUNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT �.SOUD WASTE FAcILTTYNEHK:LE <br /> OYMEi CLEANUP SITE(1VON•LOP) 0 FOOD FACaJTY 0 WASTE TIM <br /> `A UNDERGROUND TANK(MONRORING(REttOVAI) 0 Doe KENNEL 0 DAIRY <br /> 1187.HAZARDOUS WASTE GENERATOR C7 CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br /> ;WTaeI=PERMnTEDFACILITY O MOTELIHOTEL M PUMPERTRucrJYARo1CHEMTOILETS <br /> O TArroomGDY FmwNG 0 Poous A D LAND USE APPLR:ATION SITES <br /> 15 MEDICAL WAM FAcmm 0 OTHER(PLsaaa SPECIPY)- <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RENEW- MONDAY41IBOAY 6:00 AM*Q9PM - EXCLUDING HOLCAYS. <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(2081464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted-for additional assistance with file addresass,contact <br /> the EMD.Applications received after 3:00 pm will be proceamW the next business day. <br /> 2. The EHD will notify the applicant If any EHD files exist An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application. The flies will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A now <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 of the <br /> applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHD 4a4J4a <br /> 1111106 <br />