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12/16/2003 17: 54 209 -2225 MODESTO ATC PAGE 02 <br /> . ., cru wu MUMC <br /> SAN Joaqunv Co[1NTY <br /> r <br /> ENVIRONMENTAL HEALTH DEPARTINaNT <br /> 304 E Weber Ave 3d Floor Stockton, CA 95205 <br /> cl209)468-3420 Fax: (209)464-0138 Web:www.co.s=-joaquin.c2_U8/ehd Z00 <br /> PUBLIC RECORDS RELEASE APPLICATION i <br /> APPLICANT 't1 Ito 40.Y1 AX <br /> BUSINESSIAOENCY: 0� <br /> ADDRESS: gL.On� G I Y,. �-O / `~ <br /> PHONE:62= S {�a�-�� FAC5­7 6-22'2-1_ <br /> TENTATIVE'APPOINTMENT DATE: TI'TM <br /> r w <br /> (PI94es show 10 Or-7 <br /> siness days from I ds of Pp cation sutNnitta0 <br /> ❑ <br /> CHECK BOX TO EXPEDITE REQUEST•$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> DGPZA nt USS Only <br /> FILE ADDRESS /UNIT <br /> b vnl7� Unit 1 <br /> x. L <br /> i v L 3 ❑ Unit 2 <br /> �U n Vw <br /> .. �.. <br /> Unit 3 <br /> s <br /> a <br /> Ocrx Unit 4 <br /> e. st.ei n <br /> S <br /> o. so-.. <br /> ��_��_��/� - ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) 171 HOUSING ABATEMENT SOLID WASTE FACILITY <br /> El^THER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> Gt-RkZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 13 PKO TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL IHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOOMOOY PIERCING Q POOLMPA 4 LAND USE APPUCATK)N SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE 3PECIFY) <br /> 1. List up to ten addresses In the space above. Select the type(s) of files from the list above by chsckln <br /> the appropriate box(es). At least one file type MUST be selected. Fax 1x091484-0138 or mall 2_UA <br /> address Indlogtod gk2yq. <br /> 2. END 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 no <br /> application may be submitted when the file is Avallabls. anized yff pens <br /> 4 of the Any lapplicant. uture fl e reviews by the same applicant may e not returned In the same condition as released will be rerequire a$93.00 deposit prior to revle <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications roceived after 3:00 pm will be processed the next business day. <br /> ------------------------ <br /> CONFIRMED APPOINTMENT DATE TIME x <br /> DATE CONFIRMED <br /> PHONE FAX' 4NITIAL.S <br /> E. <br /> REVIEWED — YES NO REVIEW DAT - <br /> �oss.m oa <br /> uarsow <br />