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08/16/2002 11:44 209-57-9-2225 MODESTO ATC PACE 01 j <br /> SAN JOAQUIN COUNTYPUSLIC HEALTH SERVICE$ <br /> ENVIRONMENTAL HEALTH DIVISION 4 <br /> .r 304 EAST WEBER AVENUE,THIRD FLOOR EID <br /> STOCKTON CA 05202 <br /> PUBLIC RECORDS <br /> (209)468-3420 <br /> APPLICATION <br /> yy(( AUG 18 2002 <br /> APPLICANT 1�] d-1tW 4,n411{� SUSINESSIAGENCY AXL rA►-��D�Iq�+S �NVI ti <br /> AODRI:55 1�i,�" �'��� Q\vW'. ICES <br /> IVl �L `t S 35�i <br /> PHONE �.�q S}�^ •Z�'Z 1 FACSIMILE Z'ZN9 -4.y— T_-rL T- <br /> TENTATIVI~•APPOINTMCNT DATE oe 7,—+[b TIME <br /> (PlcasP pir 7 i0 b��EQUESTO ffp c or ap) lion 3UbInill7l) <br /> u CHECK BOX TO EXPEDITE REQUEST-SIr7.00 F_r , <br /> RO�-ID <br /> IN!ti <br /> U51NC55 DAYS <br /> SIGNATURE OF APPLICANT [TATE `I3 Iv'�A-AZ <br /> FILL ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM CL.EMENTS SEARCH <br /> S ate. .T+roc t31V , .Sk4�1c4on a b <br /> 4 to on �ao1� S#t3C k4�+ 4V ------ - - <br /> 1Z l�.Rll- fl;;.��at 1aVtrnvi ivlQve4Ct d'a <br /> °t'3 « 1��.Io, l3 Z +tAoli jj <br /> td't5 t,1a3f CGGd <br /> �� �c�Z� t4wrkr a 5� K1o+n rA.z <br /> Zl`t 1 c�J �} Irl is <br /> �3 EIyH ,1 w� Z.�• 5�-aClt4nn <br /> 1111 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(VST)CLEANUP SITE(LOP) 17 HOUSING A13ATFMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDCRGROUNO TANK(MONITORINGIREMOVAL) O DOG KENNCL 0 DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 4 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTF,D FACILITY ❑ MOTEUHbT9L _ O PUMPERTRUCK/YARDlCHCM TOILETS <br /> ❑ TATTOO/BODY PI;IrtCING ❑ POOLISPA O LAND USE APPUCATION SITES <br /> I MEplCgt_WA57�FACILITY O PUDLIC WATER SYSTEM d OTHLR{PLCASC SPECIFY.ABOVE-) <br /> 1. List up to ton addresses in tlt¢space above. Select the type(s) of files from the list above by checking <br /> tti¢appropriate box(es). At least one filo type MUST be selected. Fax to (2091464-0138 or mail tothe <br /> address in lcated ab va <br /> 2. I:HD 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 ton(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 availab)o for review. A new <br /> appltcation may be submitted when the file is available. <br /> 4- Any fila not returnod in the same condition as r0le480d will be reOrganizad by END staff at the expense <br /> of the applicant. Futuro fila revlows by the same aApllcant may require a$117.00 deposit prior to review. <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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX <br /> INITIALS <br /> RCVIEWEp � <br /> EN 0 7f Q p0 <br /> YES NO REVIEW DATE= <br />