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05/03/2006 11:34 209-579-ifMODESTO ATC PAGE 02 <br /> DATE RECEIVED g C <br /> HD LOG NUMBER <br /> ENVIRONMENTAL <br /> QUIoTTI� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,V4 Floor,Stockton,CA 95202-2708 <br /> Telephone,(209)468-3420 Fax.(209)464-0138 Web:www.$jVY.01Vthd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: i1 BUSINEWAGENCY: A -9 <br /> ADDRESS: 110 L ft w y_M1.M,... — ^PHONE <br /> l-- <br /> PHONE(1):. 1_+� fa �-174_' PHONE(31: FACSIMILE: 7_ <br /> TENiTAT P/W APPOINTMENT®ATI=: 6.0-Cim Tone: &loft <br /> (Please allow 10 business days from date of application submittal-*T040m only-must be confirmed) <br /> CHECK BOX TO EXPE E 693.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 0113IN S DAYS <br /> SIGNATURE OF APPLICANT DATE ' <br /> UNiT DISTRIBUTION O Una 1 0 Unit 2 UniA Unit 4 ®Unit 6 Unit 8 ❑ Other(eleCft=I <br /> FILE AODRES; EHD USE ONLY r <br /> * Bt vM Name City . <br /> F344. <br /> `i 'E. i-^r t;.es�► <br /> pr <br /> �e <br /> 8. <br /> 0. <br /> 10. <br /> Spealflc Data Range of informeMon Requested:From �" to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDER*Ftcuw TAmK(UST)CLEANur arm(LOP) 0 Houwm A®ATEmm 1CjiVJD WASTE FApurYNEHICLE <br /> OtHM CLEANUP SITE(Nay-LOP) 0 FOOD PACKM 0 WASTE TME <br /> 1 Uxmmn umo TAw(MowroRiNcMmwAsj 0 Doe KEwEL 0 DAI;rY <br /> yia HAaARDaus WASTE GeHERgTGR i7 CHICKPI RANCla Ca WABTzWATER TREATMt?itT PLANT <br /> JS Tw=PER14 mD FAc !i Y 0 MoTMJHOTCL O PurAPEER TRucgNARD(CHrA Tomm <br /> 0 TATTOOMODY PMRCM 0 PooUSPA 13 LAND USE APPUCATmN Erms <br /> Is MwwAL WAare FAciurr ❑OTHER(PLS SIH±aFY) <br /> WFLL AND SEPTIC PERM RECORDS ARE/IAyALLABLE FFR REwiFw-MmDAY-f mAY S:DD AM-I$:Nm - EXCLUDING HMMAYS. <br /> 1. List up to ton addresses In the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to 52091464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted-for additional assistance With file addresses,Contact <br /> the EHD.Applications meived after 3:00 pm will be processed the next business day. <br /> 2. The EHD Will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application, The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively being Worked on by EHD staff may not be immediately available for review. A new <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 EHEC staff at the expense of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 7-- <br /> END46-U406 <br /> 1MNQn <br />