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2�9-5 l9', 25 MODESTO ATC r , <br /> 63/30/2001 17:21 �,,� 5792225 P.Q2 <br /> TO <br /> 03-01-2eeo FRO,'". <br /> SAN JOAQUIN,GOUNTYpUBL(C HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION L <br /> 304 EAST BERT VI CA ,THIRD FLOOR <br /> S S�- <br /> 202 <br /> (209)488-3420 <br /> - - PUBLIC RECORDS RELEASE APPLICATION <br /> �y BUSIHLSSIAGENCY <br /> APrLl - <br /> y'{:VJ vav� 5.3 s f <br /> �,ou-e, �alvtin � Ste:�•- l3 <br /> ADDR�ss (�1� — Z�9 5 9i Z2z 5 <br /> PMONt: Za`l FACSIMILE <br /> r� 51`U i TIME (�Q� <br /> TENTATIVE*APPOINTMENT DA7>t bmletaF) <br /> {f�Io7se QiYe T S•10 buSinC75 days troll date vS ztPPrieatir:n su <br /> .rE CItECK Box To RXPEDITE REWEST•E7d.0' FEE-.REQUEST PROCESSED IN S BUSINESS IDAYS <br /> _ DATE 3 4i <br /> SIGNATURE OF APPLICANT /UAIJ + <br /> f TLE ADORES$ <br /> } 1l( vJ a S R>L�EJh �s <br /> IX <br /> kQ,.9oG S�AG1��L1� J5 3� W ,rLna o-d S1,oc � S <br /> .i d- . <br /> k <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> J Uf4DERGROUND TANK{UST)CLEANUP$47C'!(LOP) 4 IiaU5I4G ABATEMENT QSOttD WASTE>rACILi7Y <br /> -fQX FACILITY r3 SOLID WASTE VE!{IGLE IY <br /> )K UNDERGROUKE)TANK IM015tT6R&*j REMOVAL)'' d 'OOG'KENNEL�- ` ••« 4a .i �SRY;-. w -- - <br /> 0 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 'PKG TRLATM r'wJktaT <br /> 0 TIERED PERrdrrTED FACILITY 0 MOTPLIMOTEL C) PUMPER TRUCKfYARD/r,"f M TOILETS' <br /> n TATTOO1600Y PLIRCING 0 PODUSP.A D (.AND Use APPLICATION SITES <br /> Cl MEDICAL WASTE FACILITY 0 PURI-IC WATER SYSTEM Q OTHER(PLEASE SPECIFY ABOVE} <br /> 1. List up to tan addreSses in tha Spalk;e above. Select the typo(a) of files frorn the Het(above by checking ' <br /> i. the appropriate box(as). At least.ono file type MUST be selected. Fax t 201464-0120 m <br />�. ��IrgsS ir±Sii4xtsd..�.Sty@: <br /> 2. END will notify the applicant if any EI"lD files exist. An appointmsnt for review will be confirmed <br /> approximately five buaine"days but no laterrthan tan (113)days after receipt of application. Tht files <br /> will be held for a maximum of five business days for review. Appolntments should be scheduled <br /> accordingly. <br /> 3. A fele that is actively bring worked on by EHD staff may not be immediately availabie for review. A new <br /> Application may be submitted when the file is avall0la. <br /> 8. Any file not returned in the same condition as released will be reorganized by END staff at the okpense <br /> of the applicant. Future fila reviews by the same applicant may require a $78.48 deposit prior to review.- <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHO staff. <br /> 8. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE" <br /> TIME <br />' DATE= CONFIRMED .�- ^-,._-- -- PHONE FAX INITIALS <br /> LREVIEWED YES ;NO - - REVIEW DAT TOTAL P,02 <br /> �J <br /> i <br /> I� <br />