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10/04/2002 11:12 209-579-2225 MODESTO ATC PAGE 01 <br /> . ... .............. . <br /> SAN AQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 0 304 EAST WEBER AVENUE.THIRD FLOOR 420 A002 <br /> STOCKTON -3 95202O <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANTj wl �t/y��gr'r BUSINESS/AGENCY ATC pG�„JGt LR <br /> ADDRESS++ I( <br /> � t L <br /> j. —R flod�e CA J <br /> PHONE_ LOR S 9" Z22FACSIMILE tatlq A n2_ <br /> TENTATIVE"APPOINTMENT DATE <br /> TIME rH <br /> (Plcaso C _ TUERMIT/SERI a 7to 10 bs= ays Ida4EN313USINEss <br /> PPllcwoVICESusumaiU <br /> CHECK BOX TO,CXPEDITE REQUEST- 0 FC��T P <br /> DAYS <br /> SIGNATURE OF.APPLICANT <br /> DATE <br /> FILE ADDRESS is SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> WO <br /> a »d Cweer /5 S t IRd S. Es �., <br /> lee <br /> e F.,r»�S 5�5g SCaf er. v S k <br /> B -t 50.>c s 2353 �- 1 7.; <br /> y r <br /> Ln <br /> r r 425 �a i? `Trac <br /> 'RM 3 350 Trt„c 8 S. TvA <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT d SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY <br /> UNDERGROUND TANK(MONITORINGIRCMOVAL) 0 DOG KENNEL O SOLID WASTE VEHICLE <br /> 0 HAZARDOUS WASTE GENERATOR DAIRY <br /> 0 TIERED PERMITT-D FACILITY 0 CHICKEN RANCH O PKG TREATMENT PLANT <br /> 0 TATTOOIBODY PIJIRCING 0 MOTPUMPER TRUCIVYARD/CHEM TOILETS <br /> 0 MEDICAL WASTI'FACILITY 0 POOUSPATEL SPA O 0 LAND USE APPLICATION SITES <br /> 0 PUOLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to.ten addresses in the space above. Select the types) of files from the list above by checking <br /> ttie appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br /> 7ddress'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 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 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 487.00 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 TIME <br /> DATE CONFIRMED PHONE FAX <br /> INITIALS <br /> REVIEWED YES NO <br /> EN 00 tt AN REVIEW DATE od <br /> /00 <br />