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09/11/2002 16:07 209- 79-2225 MODESTO ATC PAGE 01 <br /> 0 . 0 9 <br /> o fLIII'\`,��� �) S IN COUNTYPUBLIC HEALTH SERVICES Nr ( �rp,�Ih �� <br /> L ` ENVIRONMENTAL HEALTH DIVISION <br /> L \� - I. \�l_�� <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> SEP 1 2 2002 STOCKTON CA 95202 SEP 1 2 2002 <br /> (209) 468-3420 <br /> MVjgONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION ENVIRONMENT HEALTH <br /> MI <br /> APPLICANTPERO 8USINESSS/AGENQCY p Q. <br /> -7 n V <br /> PHONE - FACSIMILL�t� S /1 <br /> TENTATIVE'APPOINTMENT DATE �i Af/0 TIME �(/•-� <br /> (Plcaac diva 7 to 10 business da Irol Col iPication aUbn,11 l)CHECK BOX TO,EXPL'DITE REQUEST- 7.0� -QU ROO S DI BU51NE$S DAYS <br /> SIGNATURE OF AWPLICANT DATE 9 II UL_ <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> LLPROGRAM ELEMENTS SEARCH <br /> Ar-16v� SSG �. <br /> 14ujw 941 <br /> f S <br /> fi4. n <br /> G <br /> 13 E o <br /> W o <br /> O Gus <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> O-UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> X OTHER CLEANUP SITE(NDN•LOP) 13 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL O DAIRY <br /> O HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIEREDPERMITTDFACILITY ❑ MOTaUHOTEL ❑ PUMPER TRUCKIYARDICHEMTOILETS <br /> O TATTOOIBODY PJACING ❑ POOLISPA "" D LAND USE APPLICATION SITES <br /> O MEDICAL WAST9 FACILITY O PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List Up to ten addresses in the space above. Select the type(s) of files from tho list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0130 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 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 file not returnod in the same condition as released will be reorganized by EHO staff at the oxponsa <br /> of the applicant. Future file reviews by the same applicant may require a$07.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates 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 INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Yw oY1� e�)Ipp , <br />