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09/ 11 / 2002 16 : 07 209 -579-2225 <br /> MODESTO ATC PAGE 0.1 .1 <br /> C) � IINCOUNTYPUBLIC HEALTH SERVICES INr� (a �REC °`I IOIvN <br /> 1 L l <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> SEP 1 2 2002 STOCK:TONCA95202 SEP 1 2 2002 <br /> (209) 468=3420 <br /> ENT HEALTH PUBLIC RECORDS RELEASE APPLICATION ENVIRONMENT HEALTH <br /> APPLI gNRMI O gUSINEsslAGENCY <br /> ADDRESS II1�1 11Q - B <br /> PHONE — FACSIMILE <br /> TENTATIVE' APPOINTMENT DATE � Af/0-;l, TIME <br /> (Plcanc vivo 7 to 10 business dD�U Iro1 o orapallcation .Wmltlal) <br /> © CHECK BOX TO,EXPEDITE REQUEST - 7.0 - QUROcl DI 90USINESS DAYS - <br /> SIGNATURE OF 4PPLICANT DATE 9 11 Ul- <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> I'/ <br /> $ e <br /> ckBill A , nAmlll <br /> cD c <br /> 13st E o <br /> TLa <br /> O bus <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Je�UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE (NON•LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL O DAIRY <br /> ❑ HAZARDOUS WAsTI: GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITT - OFACIUTY ❑ MOTEUHOTEL 0 PUMPER TRUCIVYARDICHEMTOILETS - <br /> ❑ TATTOOIaODY PiJIACING ❑ POOtJSPA - ❑ LAND USE APPLICATION SITES <br /> i <br /> ❑ MEDICAL WASTIt FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) <br /> 1 . List up to ten addresses in the space above, Select the type($) of files from the list above by checking <br /> ttie appropriate box(es) , At least one file type MUST be selected, Fax to (209) 464.0136 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 maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3 . A filo 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 releasod will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a 407.00 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 INITIALS <br /> REVIEWED. YES NO REVIEW DATE <br /> YH o0 � <br />