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08/29/2003 15: 23 209-57225 MODESTO ATC PAGE 01 <br /> DATE RECEIVED EHO LOG NUMB' <br /> SAN JOAQuuv CoLWTY <br /> (� ENVIRONMENTAL HEALTH DEPARTMENT <br /> U U� E-,,�11m/lgg 304 E Weber Ave 3'd Floor Stockton, CA 95205 <br /> (209) 4 8-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> AUG 2 9 2003 <br /> pp PUBLIC RECORDS RELEASE AtPPLICATrION <br /> APpLICANf/S-� ' �u SI <br /> BUSINESS/AGENCY: TG AyjoC/GreJ �C <br /> ADDRESS:0o�9I-I 79� 222/ <br /> PHONE: al.►, Ave Su.fe Br— pM«P�sto� CA 9S.3s( <br /> 57 FACSIMILE: l �77' <br /> TENTATIVE`APPOINTMENT DATE: -Sem o2t,;103 Time: OHO <br /> (Please allow 10 business days from data of eppllcation submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 'V DATE Z9/p3 <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> ev« a '1��?c+r-- ❑ Unit 1 <br /> sin o xncP >h: 4 a •alt ca f s Pic <br /> CNe�)Pc.t 9�J3 ✓� ❑ Unit 2 �q <br /> a9 56) see 12poo e s M k aty N4*7-ecg3 <br /> 3's a�« 98 t v a �.e7tct r33� Unit3 <br /> 35 8e. = ys9 of [_ a e.92 7 3 <br /> 7. sn., w i S64 a "Iwca 9SS76 Unit4 <br /> ePly <br /> 9. 9wN <br /> aly ❑ Unit 5 <br /> 0. 9Vee a <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 2 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> a> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> lm UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR 13 CHICKEN❑ MOTELI OTEL RANCH <br /> (0 PKG TREATMENT PLA14T <br /> ❑ TIERED PERMITTED FACILITY ❑ PUMPER TRUCK/YARDfCHEM TOILET! <br /> ❑ TATTOO/800Y PIERCING ❑ 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)484-0139 or mall to the <br /> address Indicated above. <br /> 2. EHD will notify the applicant If any EHD tiles 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 fllel <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 nt <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 END staff at the expen: <br /> of the applicant. Future fila reviews by the same applicant may require a $93.00 deposit prior to revit <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 /> Ho«-0zaae . <br /> - srortooa <br />