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04/11/2003 06:29 209-579 ?25 MODESTO ATC -` PAGE 01 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> APR l 0 2003 ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST wEDER AVENUE.THIRD FLOOR <br /> ;.NKjE-NT HCAL.TH STOCKTON CA 95202 <br /> C'�'r;f�,1�1TJSERVICES pUBf.,( (209) 469-3420 � � I <br /> C RECORDS RELEASE APPLICATION <br /> APPLICANT Y IA—r pL•,1 ,� �(Q� <br /> BU5INESSIAGENCY <br /> ADDRESS 1 I LID.^` t u., -Av g. <br /> AA Qr� <br /> o SA <br /> -----�� _ _,•FACSIMILE /9 'Zi <br /> TENTATIVE"APPOINTMCwr oATE <<'2S3TIM <br /> tPlcasC give Y IV 10 bv.tnas:days(rain dale of aypli al ort:ubnulQiJ [ �]�)y— (4-XI-03 <br /> Z? I <br /> 0 CHr_CIC DOX TO•EXPCDITE REQUEST-$87.90 FEE-RCQUk5T PROCESSED IN 3 BUSINESS DAYS <br /> 4 <br /> SIGNATURE OF APPLICANT -Al L"is <br /> DATE <br /> ted......... <br /> FILL A4DRC55 THIS SIDE CIiD 57AFr'W;L ONLY �. <br /> a <br /> PROGRAM 1_>wEMCHTS 3EARCH <br /> � C <br /> - <br /> M'aIva _ _— <br /> 1 M4►�.n S i r�t Yo <br /> a.A c c, i, I <br /> `�'� � - M i. S t , til n„��[ �g � ��. __—.•�,.,.�� <br /> ' ENVIRONMENTAL HEALTH DIVISION FILES <br /> PIRGROUNDTANK LUST)CLCANUP SITE(LOP) 0 HOUSING ABATEMENT j <br /> 0 OTHER CLCAANUP SITE(NON-LOP) C3 ❑ SOLID IYASTE F11.iLITY rOVO FACILITY ❑ <br /> O VNDCRGROUND TANK(MONITORING/Ar-MOVAL) O DpG KZ;NNEL SOLID WASTE VEHICLE <br /> ❑ HAZARQOUS WAS TC CJ:NCRATOR ❑ CHICKEN RANCH t7 DAIRY <br /> 17 TIERED PERMITTr D FACILITY ❑ 0 PKG TAUATMEN'r PLANT <br /> O TATT001800Y PWRCINGMOTEL/HbTEL ❑ PUMPERTRUCKTARD/CHEMTOILETS <br /> 0 MEDICAL.WA5Td FACILITY ❑ POOLISPA 0 LANG USE APPLWATION SITES <br /> 0 PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the typc(5) of files from 1110 list 41,ave by Chocking <br /> the apprcinriate box(es). At least one file type MUST be ddsalpcted. Fax tq (Zea 454-t macI 10110 <br /> o(he <br /> aress'indicated above. }1;��r <br /> 2. EHD will notify the applicant if any !_HD files exist. An appointment for review will llc2 confirmed <br /> approximately five business clays But no later than ton 00) days afterrec.lpt of alfplication. The files <br /> will be held for a maximum of five Business days for review. AppointmcnIs should be Scheduled <br /> aCCordingly, <br /> 3. A flle that is actively being worked on by EHD staff may not.be immediately rlvailablr f•:Pr raviav/• <br /> application may be submitted when tho filo is available. <br /> A now4 Any lilt not returned in the same conditiol-I as released will be VC0fUanized by EHD ;;Taff at 1110 QXpenae <br /> of the applicant. Futuro fisc reviews" mu by the sam* applicant may require 4!;07.00 deposit prior to review <br /> 5 "TENTATIVE appointment dates must be confirmed with EHO staff. <br /> 6 Applications received after 3:00 PM will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE <br /> TIME <br /> DAVE CONFIRMED <br /> PHONE FAX INITIALS <br /> REVIEWED YES NO <br /> " ° REVIEW DATE ' <br />