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11/10/2003 16:20 209-579-2?25 MODESTO ATC � . PAGE 01 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> NOV Z 0 2003 ENVIRONMENTAL HEALTH DIVISION <br /> ENVIRONMENT HEALTH 304 CAST WEBER AVENUE,THIRD FLOOR <br /> STO <br /> PERMIT/SERVICES ZKT009) 68 -3 25202 <br /> 0 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT__Drew 0.✓\ A`1e^ BUSINE55fAGENCY A <br /> ADDRESS l Loup %k-A '}wt, Sa.'4t D. rlo�tt{o 1-f4 ^� <br /> PHONE Z"OQ FACSIMILE T,101 .5 --tvL <br /> TENTATIVE'APPOINTMENT DATE__.// (L {I V� TIME 09 <br /> Sd <br /> (Phase 6ivc 7 W 10 buainoss days from data of application sulmiillal) <br /> CHECK BOX TOAXPEDITE REQUEST-$67,00 FEET RCQUEST PROCESSED IN]BUSINESS DAYS t L. <br /> SIGNATURE OF APPLICANT P Aw DATE f f/haf A z, <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> OZ oN .t t/�vt $}Qct <br /> I''I�' o r•do r_K � <br /> � Hsa^��. t♦ la SiptK <br /> zoo s. et 5orw4o -s 4v--J jzrt.� Co <br /> 11 s'+ 'Ei A owJQ sjrt } 54o.Jc is <br /> �( 5 &T .pdn4Q 5{ otKlor <br /> �f fC' vim: �L bA.Jt k1a� <br /> 31"t-0a #_") n o►d 54oCK s a <br /> 050 ori LK <br /> Jt t0 / U,ta S 3 t.1cEo-. <br /> �./ ENVIRONMENTAL HEALTH DIVISION FILES <br /> M UNDCRGROUND TANK(UST)CLEANUP SITZ(LOP) O HOUSING ADATEMLNT O SOLID WASTE FACILITY <br /> O OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIRCMOVAL) ❑ DOG KENNEL O DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITT;D FACILITY ❑ MOTELIHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PHIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> O MCOICAL WAS-rd FACILITY O PUBLIC WATER SYSTL^'M ❑ OTHER(PLEASE SPECIFY ADOVE) <br /> 1. List up to ten addresses in the space above. Soloct the types) of files from the list above by chocking <br /> tfic approipriate box(es), At (cast one file typo MUST be saloeted. Fax to (_209) 484-0138 or mail 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 hold 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 file not returned in the some condition as rcicasod will be reorganized by EHD staff at the expense <br /> of the applicant, Future file reviews by the same applicant may require a $87.00 deposit prior to rovlow. <br /> 5• 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 5• Applications received after 3;00 pm will be processed the noxt business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> `REVIEWED 1:YES NO REVIEW nATF <br />