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04/11/2003 08:29 209-579 `25 MODESTO ATC PAGE 91 <br /> 1n} 1!.�f .IIC� �o� <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVIO-ES <br /> APRT 0 2003 ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WESER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 O <br /> �tl=_ iF,AITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT A ((Q,,� <br /> 13USINESS/AGCNCY <br /> ADDRESS f l l 'i L,to.�.c ( .,,,, Av�.•� S�.'� j� M�a��o � _ <br /> PHONE Zv4 S'' L-LZ <br /> FACSIMILE Z,�Dc� 4Q _ •Z'ZZC�� <br /> TENTATIVE'APPOINTMENT OATI: 44/ZS•` -C• 3 TIMEQ ���-- <br /> (Please giva Y to�p businaxs days kw-Val.or aPI)III l Oh:ubm�tlal) �V�I-O� <br /> CH[C'K BOX TO,CJtPEDITE RCQUEST-$07,00 FEE-REQUIZST PROCESSED IN 3 13USINCSS DA YS <br /> SIGNATURE OF 4PPLICANT .CAnr V o, A.Al / <br /> DATE _ r�ItitQ� <br /> FILE ADORCSS THIS SIDt.CIiO STAFF'V::L'ONLY <br /> PROGRAM 1_LLMENTS SEARCH <br /> �Mob —' _— <br /> 3C) !6It. a <br /> u5 +Scal•a.. ��wf J~�cal�,.,, _-•.,�-- — - <br /> t <br /> AA <br /> lMa�,n S t-ra� <<. / � -- <br /> Q.A c4 . - <br /> 4 N- A& ^ s t . AA a.�t It r g _�... <br /> a <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> )(00'UN01!RGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT <br /> O OTHER CLCANUP SITE(NON-LOP) O FOOD FACILITY O 0 SOLID WASTE FACILITY <br /> ❑ UNDERGROUND TANK(MONITORINGf13CMOVAL) O DOC KENNEL SOLID WASTE VEHICLE <br /> O HAZARDOUS WASTE GENERATOR O DAIRY <br /> Q TIERED PERMITTKD FACILITY O CHICKEN RANCH O PKG TRCATMCN•r PLANT <br /> 0 TATTOO/BODY Pk)IRCING 0 MOTELMbTEL O PUMPER TRUCKWARD/CHEM TOILETS <br /> O MEDICAL WASTI FACILITY O POOLISPA ❑ LANO USE APPLICATION SITES <br /> 0 PUBLIC WATER SYSTEM O OTHER(PLEASE&PECIFY ABOVE) <br /> 1• List up to ten addresses in the space above. Select the type(s) of files from file list above by checking <br /> tfic appropriate box(es). At (cast one file type MUST be sclocted. Fax tO !Zpg a 34-LII r mailto the <br /> address'indic:ited above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will Illid <br /> approximately five business days but no later than ten(10) days after receipt of application. The files. confrme <br /> Will be hold for a maximum of five business days for review. Appointments should be Scheduled <br /> accordingly, <br /> 3. A file that is active) bcin worked on b EHD staff May not be immediately Available for roviovi. A noW <br /> Y g Y Y <br /> application may be submitted when tho filo is available. y <br /> 4- Any file not roturned in the same condition as rcicascd will be reorganized by EHD ;staff at the pxpenso <br /> of the applicant. Future file reviews by <br /> 5 atthe saame applicant may require 507.00 deposit prior to rrviow. <br /> 6• "TENTATIVE appointment des must be confirmed with EHL)staff. <br /> Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME __ <br /> DATE CONFIRMED �'"`� ------ <br /> PHONE FAX INITIALS <br /> REVIEWED <br /> -�� ° ,• YES REVIEW DATE <br />