Laserfiche WebLink
04/11/2003 08: 29 209-579-94t25 MODESTO ATC PAGE 01 <br /> irl!I_� "I`-='` �` . 'SAN'N JOAQUIN COUNTYPUBLIC HEA C <br /> LTH SEFtJI...ES <br /> APR 1 0 2003 ENVIRONMENTAL HEALTH DIVISION <br /> . 304 Eq$Z'WEBER AVENUE,THIRD FLOOR <br /> ;"''"'.. ,,NIVIENT HEALTH STOCII CA as2oz!j1 (209)468-34202LI19 <br /> ��RIM1ITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT r l-a- r n — ,��(Q AA 1•� �"��„� "--- `' <br /> BUSINESSIAGENCY J� t <br /> ADDRESS MAiC4 s�/q <br /> PHONE Ty't _FACSIMILE Z•U0l � 'z`ZZ_5� <br /> TENTATIVE*APPOINTMENT BATE <f�Z�l�3 TIME Q 1 �{- I j <br /> (Please(Live 7 ld 10 b�:inaas dayr.train dale of applieatlor,:ubntillal)`— <br /> . , <br /> Q G!i[CK nOX TO•E(PEOrrE REDDEST-4117.oa FGC-REQUEST PROGE55arp IN 1 UUS1N[55 DAYS �� 4, <br /> SIGNATURE OF APPLICANT <br /> MATE (� <br /> FILE ADDIiCSS THIS 31 Flip SrAFr•'V;;z ONLY <br /> .i <br /> PROGRAM LLUMENTS S1_ARCH <br /> If 610 <br /> x`11 -1 <br /> �5 JSCaI+a,.. ��K �tat �•. r --�-.--� <br /> ------------ <br /> C CQtAn �V{avt. �'SC4t�/► r ��- . <br /> (vd <br /> Q.a C C , <br /> AAa.�tt [q <br /> �/ ENVIRONMENTAL HEALTH DIVISION FILES <br /> yC I � <br /> UNOPIRGROUNO TANK JUS n CLEMUP SITE(LOP) GI MOUSING A13ATFMENT � souO 1VA5TE FACILITY <br /> ❑ OTHER CI.11ANUP SITE(NON•LOP) 0 FOOD FACILITY <br /> Cl UNDERGROUND TANK(MON ITORINGJAEMOVAL) ❑ DOG KENNEL Cl SOUL?WASTE VEHICLE <br /> O HAZARDOUS WASTE GENERATOR (3 DAIRY <br /> d TICRCO PERMtTTgD FACILITY n CHICKEN PANCN t3 PKC TRaATMCN'r PLANT <br /> Q TATTOOIBODY PUIRCING O MOTELIM)YEL <br /> [7 POOLISPA �- _ C3 PUMPER TIiUCK!1'ARd1CFICrY{TOILETS <br /> C3 MEDICAL WA5IT <br /> 'rd FACILITY ❑ LANG)USE APPLICATION SITES <br /> D PU13UC WATC-ft SYS.TCM ❑ OTHER(VLEgS&4PECiFY AUOVQ. <br /> 1• List up to ten addresses in tlzc space above. Select the types) of files from the list :ebovc by nc�ckini� <br /> the a <br /> p S'in etc box(es). At!cast one file type MUS be selected. Fax to '�0'J aria-11.1 tI r ail to the <br /> re sin ir.7(cd above. <br /> 2. EHD Will notify the applicant if any EHO files exist. An appointment for review will Ilrr confirmedI <br /> approxiinatcly five business days but no later than ten (10) days afterrecolpt of ajjFjIicalion. 71 c files <br /> Will be held for a maxilr(um of five business days for review. Appointments Should be scheduled <br /> accordinipy. <br /> 3• A file that is aCtivcly bcin0 worked on by EHD staff may not be by EHD ;:tatf at otic expense <br /> rpviev[. A now i <br /> application may be -Subrnittod when the (JIG is available. imrrsadialaly r,vailablr. (sir <br /> 4' pplicat <br /> Any file not rOtUrnCtl 111 the SAmF Gpconditionas released wit! be <br /> of the applicant. Future filo reviews by the same apTaorpanitccl plicant may require A'567.00claFoait prior to review. <br /> 5 'TENTATIVE appointment dates must bm e confirmed with EHD staff. <br /> 6• Applications reCCiVed after 3:00 <br /> p wil! be processed the next business daffy, � <br /> CONFIRMED APPOINTMENT DATE <br /> TIME � <br /> DATE CONFIRMEo <br /> PHONE FAX IN'ITIALS <br /> REVIEWED Yr--s <br /> �i o a� Too REVIEW DATE ' <br />