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12/09/2003 10:51 209-5- 1225 MODESTO ATC PAGE 01 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> oEC 0 2003 ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> a n �. , 1, STOCKTON CA 95202 <br /> _ �i�,!t�} (209) 4138-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT �`^ �\��^ BUSINESS/AGENCY <br /> ADORESS CII Lb-Ai '�ol,�.; A,j-k, S–s•'!-� Q, Moe?-os{� �S�sl ._—._ <br /> PHONE;ZNo S"jR - Z 21 1 FACSIMILIi <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Plcaso Vivo 7 to 10 businc" days froin dato of aPiAration submittal)-Nr1 I't II <br /> CH!~CIC BOX TO,EXPEDITE REQUEST-Sr17.00 F L•-REQUEST PROCCSSED IN 3 13USINL•SS DAYSI <br /> SIGNATURE OF APPLICANT �``�N ��—�`� DATE t Z�t A 3 <br /> FILL"ADpRCSS THIS SIDE CHO STAFF USE ONLY <br /> PROGRAM CLL=M[NTS SEAKCFI <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> M UNOCRGROUND TANK(UST)CLEANUP 51TE(LOP) ❑ HOUSING ABATEMENT O 5000 WASR r-,' ILVV <br /> - H <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MON ITORING/RC-MOVAL) ❑ DOG KENNEL D DAIRY <br /> ❑ HAZARDOUS WASTE GENCRATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 0 TIERED PERMITTgD FACILITY O MOTEUHOTEL ❑ PUMPER TRUCIVYARD/CHEM TOILETS <br /> 0 TATTOO/BODY P14IRCING O POOUSPA 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WAS-r1:FACILITY 0 PUfaLIC WATER SYS.TLM O OTHER(PLEASE SPECIFY ABOVE) <br /> List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(cs). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br /> address indicated above <br /> 2. EHD will notify the applicant if any EHO 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. Tile 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 i5 actively being worked on by EHD staff m-ly not be immediately available for review. A now <br /> application may be Submitted when tho fila is available. <br /> 4. Any file not returned in the Samc condition as relcasod will be reorganized Uy EHD staff at the oxpcnso <br /> of the applicant. Futurc filo reviews by the same applicant may require a $07.00 deposit prior to reviow. <br /> 5. "TENTATIVE appointment datas must be confirmed with EHD Staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day <br /> �I <br /> CONFIRMED APPOINTMENT DATE I2-(0- TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> —tI, oa „ oaMypo m <br /> 41AQ.G1,n-, <br />