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09/11/2002 16:07 209-F7,9-2225 MODESTO ATC �. PAGE 61 _ <br /> 9' <br /> W-3ZIN�} COUNTYPUBLIC HEALTH SERVICESREC ���,� (� �� �/] �� <br /> ENVIRONMENTAL HEALTH DIVISION ll 1! li l'J LU <br /> 301 EAST WEBER AVENUE,THIRD FLOOR <br /> SEP 2 2402 STOCKTON CA 95202 SEP 1 2 2002 <br /> (209)468.3.420 <br /> ENT HEALTH PUBIC RECORDS RELEASE APPLICATION ENVIRONMENT HEALTH <br /> PERMI <br /> APPLICANT O BUSINESSIAGENCY �. <br /> ADDAESS I Q 'U <br /> PHONE- FACSIMILE. <br /> TEhtTA-DIVE'APPOtNrM1=NT DATE TIME <br /> (PIConc Diva 7 to 19busi` a da frol C of ap (cation yubnilital) <br /> CHECK BOX TO,I`?(PCI}I7E ItEQUCST- 7.00�� QUEST PROC• S D1 3 BVSINF. S DAYS <br /> SIGNATURE OF APPLICANT DATE '91) �v <br /> FILE ADDRESS THIS-310E.END STAFF USE ONLY <br /> PROGRAM ELEMCHTS$15-ARCH <br /> e►�i e«+. 2sG f <br /> I 5 e t <br /> t� A r+ <br /> 00 <br /> 135LF a <br /> L <br /> tM a , <br /> 4 Gus D <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> )19-UNDCRGROUND TANK LUST)CLEANUP SITE(LOP) D HOUSING A13AYEMIZNT 0 SOLID WASTE FACILITY <br /> XOTHER CLEAl3UP SITE(NDN-LOP) ' 0 FOOD FACILITY 0 SOLID WASTE VEHI=- <br /> ❑ UNDERGROUND TANK(MO NITORINGI REMOVAL) Q DOG KENNEL 0.DAIRY � <br /> ❑ HAZARDOUS WAS Tr_GENCRATOR O CHICKEN RANCH 0PKG TREATMENT PLANT <br /> ❑ 71fcREDPERMiTT DFACILfTY Cl l9lOTELIHOTs;L <br /> Q PUMpERTRUCIVYA9DICHEM70ILETS <br /> ❑ TATTOOIBODY PhIACING Q POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL.•WASTE!FACILITY 4 PUBLIC wATCR$YSTF-M ❑ OTHER(PLEASE SPECIFY ADQVF) <br /> 1. List up to ten addresses in the space above. Select the type($) of files from the list above by chceking <br /> tfie appropriate box(es). At least one file type MIDST be selected. Fax to (209)464-0138 or mail to the <br /> addr ss indicated above. <br /> 2. EHD wili notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no Eater than ten(10) days after receipt of application,-The files <br /> will be held for a fnaximum of five business days for review. Appointments should be seh•eduled <br /> 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 oxpcnSV <br /> of the applicant. Future file reviews by the same applicant may require a$67.00 deposit prior to review. <br /> 5. '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 'GIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED .+ YES NO REVIEW DATE <br /> K 00 44 '96MM4 <br /> wr <br />