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05/14/2003 10:01 209-579-2?99 MODESTO ATC PAGE 01 <br /> DA'M RE"MM <br /> r.S,o goo nAec� <br /> SAN JOAQUIN COUNTY <br /> Ib1 IY 1 �(l� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> i r i 7 STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT fl rt�w a r. «e �. BUSINESSIAGENCY .4rC <br /> ADDRESS I k k t Lost PCI w+ J<✓A�J E 5.�� �L S� . /V1 ' !${p ---- — - <br /> PHONE Zn9 5 ^ZZZ l FACSI1MI1-1: <br /> TENTATIVE"APPOINTMENT DATE SI�� TIME �[O 1-'O <br /> (Please give T to 10 businmm d"from daft of application sulim-tial) <br /> CHECK BOX TO EXPEDITE REQUEST-$8.00 FE -REQUEST JPROCESSED IN 3 BUSINESS DAYS <br /> MI <br /> 1• <br /> SIGNATURE OF APPLICANT D/ulw �U.- DATE 5 <br /> FILE ADDRESS THIS SIDEiEHI;STAFF= USE ONLY <br /> PROGRAM ELEMENTS SEARCII <br /> Aje.. I .-�/2 <br /> 235-3 '(-otic, ooa 1"rct <br /> c-Sc�F, Mo off- vd Mca-��c-tI� � 3r � ---- <br /> 2'343 — <br /> 'S <br /> -''09 - <br /> 15 W.U-111 <br /> ti M ae c d o I�. S-fY-tom+ 1 c L, p / 1 - -- <br /> #,-j <br /> -Pe <br /> ENVIRONMENTAL�IEALTH DIVISION FILES <br /> Ja. UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSl1IG ABATEMENT ❑ ;,01.11)MI hSTE FACILITY <br /> O OTHER CLEANUP SITE(NON-LOP) 0 FOOD r-ACRJTY 13 ;;OLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKE:N RANCH ❑ $101 TRE nTME?a PLANT <br /> ❑ TIERED PERNIMED FACILITY ❑ MOTEL'HOTEL ❑ PUMPER TRUCIVYARD/CHEM TOILETS <br /> O TATTOOMODY PEIRCING O POOLr.5PA ❑ LAND U7 E APPLICATION 31"ES <br /> O MEDICAL WASTE FACILrrY 0 OTHER(PLEASE SPECIFY) <br /> 1. List up to ton addressees In the space above. Select the type(s) of filer from :he lint above by checking <br /> the appropriate box(e►s). At least one file type MUST be selected. EM.)Lq,=jL4464013s or mall to th2 <br /> address Indicated above. <br /> 2. EHD will notify the applicant If any EHD files exist. An appointment far revian will be confirmed <br /> approximately five business days but no later than ten (10) days after rer,:elpa.of application. Thn funs <br /> will be held for a maximum of five buslnass days for review. Appointments should bo sch,aduled <br /> accordingly. <br /> 3. A file that Is actively being worked on by EHU staff may not be immediately I vailabie for review. A new <br /> application may be submitted when the file Ili available. <br /> 4. Any file not returned in the same condition a s released will be reorgarlfzied b-f EHD stuff at the expense <br /> of the applicant. Future file reviews by the slime applicant may rrE►quirll r S8C.00 dIPpoalt prior to r4vlew. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6• Applications received after 3:00 pm will be processed the next businens day. <br /> "COWIRMED APPOIUMEN3 DATE _ <br /> DATE COI' NWED PHONE FAX INI rI.AUI <br /> Li�e,ilw oos YE$ NO RIM111W OATE <br /> ___...._, <br /> xztrioos <br />