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11/10/2003 16:20 209-579--2225 MODESTO ATC PAGE 01 <br /> ni �i�'h � CI <br /> SAN JOAQUIN COUNTYPUSLIC HEALTH SERVICES <br /> NOV 1 0 2003 ENVIRONMENTAL HEALTH DIVISION <br /> ENVIRONMENT HEALTH 304 EAST WEBER AVENUE, THIRD FLOOR <br /> PERMIT/SERVICESSTOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 1)rew Q+I� A`le-. OUSINESS/AGENCY <br /> ADDRESS U I Lo�►� o�.A,► �1,1t, S.>��c _D Nloo�tt�4 (/4 <br /> PHONE 2"04 5�`�—"Z.'2-'L l �p <br /> FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE" it [14,03 TIME 3 T' <br /> (PICoZc vivo T l0 10 buainos:Gays from dale of aplilicalion sulimitioi) <br /> ❑ • <br /> CHOCK IiOX TO,CXPEDITE REQUEST•S07.00 FEE REQUEST PROCESSED IN]tIUSINI"55 DAYS \1n l <br /> SIGNATURE OF APPLICANT _PIAAN" DATE ll�/ALc)_-�, ^ <br /> FILE ADDRL'-SS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 4 Z o 6k e t,A-( <br /> L J5 <br /> El �n,rte X14 SIr �rt.n��, C4 S <br /> �, s . .D>�r.•� s-1�0(.kb� <br /> 1+405 <br /> oQ c.a o.d scK � . <br /> .�/ ENVIRONMENTAL HEALTH DIVISION FILES <br /> V� UNOCrtGROUND TANK(UST)CLEANUP SITE LLOP) Q HOUSING ABATEMENT O SOLID WASTE VACIUTY <br /> 0 OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> C UNDERGROUND TANK(MON ITORING/R[MOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> © HAZARDOUS WASTL GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> O TIERED PERMITT;D FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHCMTOILETS <br /> ❑ TATTOO/BOGY PWIRCING ❑ POOUSPA ❑ LAND USC APPLICATION SITES <br /> ❑ M[DICAL WA3Ti1 FACILITY Q PUULIC WATER SYS.TL"M ❑ OTHER(PLEASE SPECIFY ADOVC) <br /> 1. List up to ten addresses in the space above. Select the typs(s) of files from the list above by chocking <br /> the apprcipriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 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 ton (10) days after receipt of application. The files <br /> will be held for a maximum of five business days for rcvicw. Appointments should be scheduled <br /> accordingly. <br /> 3. A filo that is actively being worked on by EHD staff may not be immediately available for rcvicw. A new <br /> application may be submitted when the file is available. <br /> 4. Any fila net returned in the same condition as rcicasod will be reorganized by EHD staffat the expense <br /> of the applicant, Futuro file reviews by the same applicant may require a $07.00 deposit prior treview. <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 <br /> INITIALS <br /> EVIEWED '— <br /> R .---- —.t— YES <br /> RNO REVIEW noTIZ <br />