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04,124/2005 10:05 209-579--025 MODESTO ATC PAGE 02 <br /> EHD LOG NUMBER <br /> SAN JoaQvnv COUNTY <br /> L ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber.Avenue, 3 d floor, Stockton,CA 95202-2708 <br /> APR 2 4 2006 <br /> Telephone: (209)468-3420 F2x: (209)464-0138 Web:www.s}gov_org/eb.c1 <br /> ENOONMENT HEI�LTN <br /> PERM)/SERVICES PUBLIC RECORpS RELEASE APPLICATION <br /> APPLICANT j �,� SUSINES8IAGENCY: <br /> ADDRESS: <br /> PHONE(1): 9�Gt.�,�(. 9 PHONE(2): FACSlEMILE:�Z�-���,� <br /> TENTATIVE"APP04MVENT DATE: ,fid t11.��� —Ttmo:�Ci"n - <br /> (Pte4me allow 10 buainas:days tram data of w1joicatlon submro lttal--TOF)MI only-must bw confirmed) <br /> C9 CHECt:Sox To EXPEorTE REQUES -$93.00 FEE(CASH OR CHI=CK ONLY)-REQUEST PROCESSED IN 3 OUSINES 3 Dffs <br /> SIGNATURE OF APPLICANT r GATE ±LZA2 <br /> UNIT DISTRI6UTK3N ❑ Unk 1 ❑ Unit 2 Unit 3 ' ; Unl!S <br /> Unit 8 ❑ other(elsctronldiluts'maf ) <br /> FILE ADDRESS EHD USE ONLY <br /> 8 Straet Name city — <br /> 4. <br /> 6. <br /> T. <br /> 9' <br /> $pacific Date Range of InfonriMlon Requested:From to y <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDE"ROUND TANK(UST)CLEANUP SrrE(LOP) M Housa+o A&ATEM0rr I4 SOIL WASTE FACft YIV•EWLE <br /> OTHER CLEANUp Snit(NON-Lop) ❑FOOD FACILrrY Cl WASTE TIRE <br /> g=uNo TANK(M11'1- tac�!'1i EMMAL) ❑Doc KENNEL 13 DAIRY <br /> $ <br /> VV.'T' <br /> aENE>RATOR ❑cKcKrw RANCH ❑WAs7nnyi ER TKEATIMEYT PW-T <br /> ❑TIERED PEFiMtil'ED FACILITY <br /> ❑MOTMJHOTT.L ❑PUraP92 TRUCKIYARDICHEM To:UTS <br /> •TATTOWBODY PIERCI a ❑POOL/SPA Cl LANG U3E APFUCATION 8"T6 <br /> ?Q MEDICAL WASTE FACILITY 0 OTHEit(PLEASE SPECGF') <br /> WELL AND SEMIC PERMrr FtEcosens ARI;AVAtIAAI-E FOR REVIEW - MONDAY-FRIOAY 8:00 Aid-5:00PM - E:ecl uma HOLIDAYS_ <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by chocking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)40-0138 or mail j=LLddreast <br /> indiCatpd above. Address ranges will not be accepted-for additional assistance with file addres sev,contact <br /> the EHD.Applications received after 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD flies exist. An appointment for review will be confirmed <br /> approximately tart(10) days after receipt of application. The flies will be held for a maximum of five busir>ass <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actCvaly being worked on by EHD staff may not be immediately avaliable far 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 eupansa of'the <br /> j applicant. Future file reviews by the some applicant may require a$43.00 deposit prior to review. <br /> I <br /> END 4942406 <br /> vlrua� <br />