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05/03/2006 11:34 209-579- MODESTO ATC PAGE 02 13 <br /> '-*'L4 <br /> DATE RECEIVED EHq LOG NUMBER JQAQt3IN�COIJN'I'Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 Bast Weber Avenue, 3r1 Floor,Stockton,CA 95202-2708 <br /> 'telephone;(209)468-3420 Fax;(209)464.0138 Web:www.$jgdv.or&hd Z :551 <br /> PUBLIC RECORDS RELEASE.A,PPLICATION <br /> APPLICANT: rrt�wc t 'L suslNESWAGENCY:Ate' <br /> ADCIRESS: ,` L 1s,$��'.A� 111°t �t^�,o &ate-•Ed-4� <br /> PHONE(1):. +� � . 'Z7_1 PHONE(3): FACSIMILE:- "y�1q' <br /> TENTATiVE*APPOINTMENT DATE: '��• TIme: 51AA0-- <br /> (Please allow 10 business days from date of applicatlon submittal-*T only-must be cot>tlm C9 <br /> CHECK SOX TO EXPE E X83.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 OU3iMESS DAYS <br /> SIGNATURE OF APPLICANT a, DATE0C 04 <br /> UNIT OISTR j;;i N E3 Unit 1 0 Unit 2 un(t 3 OC Unit 4 ©Unit 5 PFUnk 6 0 Other(afeetrcmicAtrtstmaps) <br /> FIl ADCiftES'8 EHD USE OiVLY <br /> Stn * Street Noma City <br /> F3. . <br /> '10 <br /> NP <br /> IdSto _.. - * --—......____...._._._................. _...__ l� <br /> b. �zR•" �, <br /> ti. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specilic Date Range of Information Reque :From FjT to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNCeR0ltcuNo TANK(1.187)CLEANUP SITE(LOP) 0 Housuto AaATEmEw ICSOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP&M(NON-LOP) 0 FOW FACRMY o WASTE TME <br /> UNDERaRoewTANK(mgwrORINWRt? WAL) 0 Doe KWHEL 0 DAIRY <br /> VL HAZARDOUS WASTE GENERATOR Q CWAgM RAKof M WASTEWATER TREAl"ERP PLANT <br /> 35 TWWPERWrMDFACUTY ❑MoTmA4OTcL C3 PunPERTRucWYAka/CHEMTaLET% <br /> E3 TAMWOODY PIEROM CI POOUSPA D LANu UsE APPLICATION SM <br /> 15 MEDICAL wAM FACILITY D OCHER(PL EAsa SaEcx�Y) <br /> DELL AHD SErm PERNaT REcoRm ARE AVAILABLE FM REVIEW-MONDAY-fWAY 6:00 A&I-M M - EXCL=NG HOMAY& <br /> 1. List up to ton addresses in the space above. Select the type(*)of fibs from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to 12001464-0138 or mall to the address <br /> Indicated above. Address ranges will not be accepted-for additional assistance with file addresses,C*r tact <br /> the EHD.Applications received 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 tiles will be held for a maximum of five business <br /> days for reiviewr. 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 some condition as released will be reorganized by EHO staff at the expense of the <br /> applicant Future file reviews by the same applicant may require a$93.00 deposit prior tis review. <br /> BIKi 4l.048� <br /> 1(11106 <br />