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08/29/2003 15: 23 209-57225 MODESTO ATC PAGE 01 <br /> DATE RECEIVED EHO LOG NUMBI <br /> SAN JOAQUIN COUNTY <br /> R1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> LI I, r� ',il��l� 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> (209) 42 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd /— <br /> AUG 2 9 2003 <br /> A PUBLIC RECORDS RELEASE APPLICATION yy <br /> APpLA <br /> II:AN�T�S Sf BUSINESSIAGENCY: TG As;vcl1reJ <br /> ADDRESS: p1117 Zcv1c Dalin Ave, Srw.fe B Mod&M <2 9535~1 <br /> PHONE: J" -79^ FACSIMILE: S?9" <br /> TENTATIVE"APPOINTMENT DATE: Sem I2 .z003 Time; 0800 <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$993.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> '�Li <br /> SIGNATURE OF APPLICANT l ;00i DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> w«' r?[ac— ❑ Unit 1 <br /> sixes O XniQ fjlil a a wnitca 9f�sL <br /> l Q,ln � saw 1,277 11AjVAAj_jPi1'& C.- Lart <br /> I.1Q< 9>✓J3 <br /> 29 5�/a M�.� 2poo e s oii� a a c--z 3 ✓/ ❑ Unit 2 <br /> 3 5 so-.., 98 t 91"d. U a e.Gdcr 9'336 unit 3 C �� <br /> ✓35 8e sins 75-7 0� L_- a s 7 3 <br /> v. sbeej 4%^J / Sh4 c1 "AcA 95726 UnI4 <br /> m^•' <br /> Cay ❑ Unit 5 <br /> io, so-eM city <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 03 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> q OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> tS UNDERGROUND TANK(MONITORIN DIRE M OVAL) 0 DOG KENNEL M DAIRY <br /> tB HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKTARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING O POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) _ <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checkin <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)4H-0138 or mall to the <br /> address Indicated above. <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 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 of <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 expen: <br /> of the applicant. Future fila reviews by the same applicant may require a $93.00 deposit prior to revif <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> G. 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 /> no senz<ae - <br /> - venow <br />