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209 -579:7.? -225 MODESTO ATC <br />- I - **' * V 0 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber ,Avenue, P floor, StOckton, CA 95202-2708 hd <br />PAGE 02 <br />Elip LOG NUMBER <br />01 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www•s390Y. '-&e <br />ENVIRONMENT I-IEALTN <br />PERMIT/SERVICES PUBLIC SCO � 1tELEdASE ,p�pp�.,ICA►,TYD�1 <br />sU91NESSlAGEN6:Y: <br />AP <br />ADDRESS: <br />PHONE (a): PHONs (x1: FAcsIMILE: S'i�I � <br />�. <br />TENTATIVE" APP04M MENT DATE: Tlnw: t <br />(pisssa allow 10 buslwas days from data of It�tion submittal - *TsN only. -must be rorrtlnnsd) <br />C3 CHVCK SOX TO EXPEortEREQUES - $8300 FSE (C.AaH OR 4HECK ONLY). REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF AF°PLICANTe.DATE �• �._. <br />mna,; :,121 <br />0 <br />1Y <br />0 Unit a 0 Unit B <br />U nit 4 13 Unit 5 `q unite <br />%%. 40e <br />..- . <br />specifit: Date Range of Info on Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UaoERAROuND TAMC (UST) CtEmuP SM (LOP) Q Houma ARATifMSNT a Sot® WASTE FAca t" sHime <br />® OTHER CWANUP SITE (NOW -LOP) E3 Fow FAouff 0 WASTE TIRE <br />UnDeROW N D TANK (MONITORIN@/REWYAL) 0 DO® KErtNeL 0 DA99Y <br />$ WASTE GENERATOR E3 cm cnN RANCH )3 WAgMWATER TRSATMEir PLANT <br />i D PERMrr= FACILITY M MOTELf OWL 0 PuNPER TnwodY'ARa1CHEIM ToKATs <br />0 TATrOOMM PIERCINe 0 POCUSPA © I.ANo USE APPUCATTOrt SM <br />MEO ,t. WASTE FACILITY 13 OrHEIt (PLB"E SPEQIR7 <br />WELL AN® SEPTIC Ponrr RECORDS ARE AVAILAB" FOR REVIEW - MONDAY -FRIDAY 8:061 AM'G:QOPM - EXCLUMO HOUDAY8. <br />1. List up to toes addresses in the space above. Select the type($) of flies from the lint aWvo by checking the <br />appropriate box(es). At least one file type MUST be selected. Fax Ig i; Iddress <br />Ind Cat9Apb9ve. Address ranges will not be accepted - for additional assistance with fife addresses, contact <br />the EHD, Applications recelved after 3:00 pm will be processed the next business day. <br />2. The EHD will notify the applicant if any EHO flies exist. An appointment for review will be confirmed <br />approximately ten (10) Buys after receipt of application. The flies will be held for a maximum of five business <br />days for review. Appointments should be .scheduled accordingly. <br />3. A Ills that is actively being worked an by EHD staff may not be Immediately available for review. A now <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 stuff at the expanse of the <br />aDDlicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br />VA_ <br />