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fl-IV <br /> fl3J, rQ8 209-57-9-2225 MODESTO ATC PAGE 01 <br /> SAN JOAQUIN COUNTY <br /> SEP 0 4 2003 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> '�'-'WI iUNWENT HEALT�i STOCKTON CA 95202 <br /> KrMOIT,SERVICES (209) 468.3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT i)q-f"^) o" 'mu"' BUSINESS/AGENCY /`4 LR [Stu <br /> ADDRESS LNi• t <br /> PH ONE FACSIMILE <br /> TENTATIVE`APPOINTMENT DATE <l 3 TIME �4 <br /> (101028e give 7 to 10 buainem days from date of application submittal) • <br /> ED CHECK BOX TQ EXPEDITE REQUEST-;$8.00`F E—REQUEST PROCESSED IN 3 8U81NE95 DAYS <br /> SIGNATURE OF APPLICANT '� � v DATE 4�3�4361 ,a <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Z 3s <br /> obi r d• , ! <br /> 3 a N%AX-"U'% <br /> 7�R k 1jq'i <br /> SOL <br /> 4 4- 71 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> >i4 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ASAYEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(M ONITORINGIREM OVAL) I3 DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY Q MOTELMOTEL Q PUMPER TRUCKIYARD/CHEM TOILETS <br /> 0 TATTOWBODY PEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECEM <br /> 7. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one Ills type MUST be selected. Fax t 0 464-0138 or mq1I to the <br /> addr9go Indica ve. <br /> 2. EHD will notify the applicant If any EHD flies exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt of appilcatlon. 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 returned In the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$89.00 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 /> ANIMMLS <br /> YES ko- <br /> na4s-ozao-e .y . <br /> V"M '-'C.0 CU/7A.^.71 Cl Un7 C( Lr.�• ��� / �' <br />