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11/10/2003 16:20 209-579-2225 <br /> MODESTO ATC <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> NOV 1 0 2003 ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> NVIRONMENT HEALTHbo <br /> STOCKTON CA 95202 <br /> PERMIT/SERVICES (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT D,-,j BUSINESS/AGENCY <br /> ADDRESS LOQ' -? �,1 t'�t, Sa.�L D, 1oO�lt�+4y' <br /> PHONE z 5 �—'Z.�Zt FACSIMILE <br /> ^ <br /> TENTATIVE*APPOINTMENT DATE"it �I ity} TIME <br /> (Plca.c pivc 7 to 10 buainoss uay:from date of SpI ucauon:,.ubi+til- <br /> CHECK BOX TO,CXPEDITE R[QUEST•$07.00 FEE RCOULSTPROCC55LOIN3 BUSINESS DAYS wv, <br /> SIGNATURE OF APPLICANT �J""`^' `�`�- ` DATE <br /> FILO ADDRES5 THIS SIDE CND STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> C14 !1 L <br /> ZC�4 5. EL *).Qr`,4 S+v--k Frw%0% Ca T <br /> 5'i' '�'[ .D o�.,o S�r� Soo�)�•4.0-� �' <br /> y�o 5 ate: ,L N-J <br /> 0 5� .o.�-t t.� '► G a <br /> ��{� MAS.. S. 3 t)�o-• <br /> ENVIRONMENTAL_HEALTH DIVISION FILES <br /> UNOC(IGROUND TANK(UST) CLEANUP SITE(LOP) O HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> C OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> C UNDERGROUND TANK(MONITORINGIRCMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> O HAZARDOUS WASTE GENCRATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PGRMITT4D FACILITY O MO'rEUHOTEL . ❑ PUMPrRTRUCKrYARDICHCM TOILETS <br /> C TATTOOIBODY P14IRCING ❑ POOUSPA 4 ❑ LAND USE APPLICATION Sn•ES <br /> G M[oICAL WAs•rl1 FACILITY a PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY AUOVE) <br /> 1, List up to ten addresses in the space above. Select the type(s) of files from the list above by chocking <br /> ttie apprdpriatc box(es). At least one file type MUST be Selected. Fax to (209) 464-0138 or mlil 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 file 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 fila nvt returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant, Future file reviews by the same applicant may require a $07.00 deposit prior to ravlow. <br /> 5. *TENTATIVE appointment data's must be confirmed with EHD staff. <br /> 6. Applications rcccived after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED 1 YESNO REVIEW nATF <br />