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10/04/2002 11:12 209-579-2225 MODESTO ATC ri PAGE 01 <br /> j0X0SAN JOAQUiN COUNT1fPUBLIC HEALTH SERVICES 11N t,.uj.j,,.�.�.�• <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR /0 <br /> STOCKTON -3CA 95202 0 <br /> ]] (20420 <br /> PUBLIC RECORDS �RELEASE APPLICATION <br /> APPLICAgT J_-ws � K 2Yr� BUSIH1:55IAGEHCYi t4- -?z G .jj 1R <br /> ADDRESS I I(� Icy-w A I-�, oGi/lft� _ �� <br /> 32tC <br /> PHONE oa S - �.2z exM ) 5'�j- 22. 57 <br /> FACSIMILE <br /> TENTATIVE-APPOINTMENT DATL" U -aZI -U2TH <br /> (Please pi o Y le 10 busi�icss s s Ir TIME to PFRMIT�SE VICES <br /> Y dato o pplleallan au4miltal) 1, <br /> CHECK BOX TO.EXP6TE REQUEST- 0 FEE-REQ ST P <br /> t SE N 3 L3Us <br /> INCSS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE /U— <br /> FILE ADDRESS <br /> THISS16 EHD STAFF USI:ONLY <br /> PROGRAM ELEMC•NTS SEARCH <br /> e. »d Greer l S S I �d S. Es <br /> Ill:zs- EI <br /> Y t O Arw,S S��aES14 C <br /> Seef ow v S , ✓ <br /> Dove •�f Tuf' Z35ty <br /> Y Ir M "9r2$ /-a i? 7rq� <br /> RM 4 3 350 -r,%,c i3 S. <br /> � igfy 7YuC�CIY+ �� �.ry <br /> Tr by c <br /> a. <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C] HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACIL!" p <br /> UNDERGROUND TANK(MONITORINGIRr_MCIVAL) ❑ DOG KENNEL SOLID WASTE VEHICLE <br /> C7 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH D DAIRY <br /> 0 TIERED PERMIT-rD FACILITY 0 PKG TREATMENT PLANT <br /> 0 TATTOO180DY P1411ZCING 0 MOTEL/HbTEL C7 PUMPER TRUCKIYARDICHEM-TOILETS <br /> 0 MEDICAL WASTe- FACILITY ❑ POOL/SPA O LAND USE APPLICATION SITES <br /> ❑ PUDL1C WATER sYS-TEM O OTHER(PLEASE SPECIFY ADOVE-) <br /> 1. List up to.ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> tfie appropriate box(cs).- At least one file type MUST be selected. Fax to 209 464-0138 or mail to the <br /> address indicatFd Bove. <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 appilcation.•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 new <br /> aPPHI tion may be submitted when the fife is available. <br /> 4. Any Elie not roturned 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 $57.00 deposit.prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> s Applications received after 3:00 pm will be processed the noxi business day. <br /> CONFIRMED APPOINTMENT DATE • <br /> TIME <br /> DAT!_ CONFIRMEDr.. <br /> PHONE FAX INITIALS <br /> REVIEWED YES NO <br /> sM CIOti• aro ova REVIEW DATE <br /> s <br />