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05105/2005 15:30 209-579-0MODESTO ATC r PAGE 02 <br /> �F <br /> DATE RECENED <br /> SAN JOAQUIN COUNTY 7P <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EAST WESER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 BONY _5 .AM 7i 28 <br /> (2 ) •3420 - <br /> PUBLIC RECORDS RELEASE APPLICA'I 4U1N COUNTY <br /> H tai �_R "' <br /> APPLICANTQAy1D ScPjr1 4L BUSINESS/AGENCY &TL AIS IA S <br /> ADDRESS ItIl LONE &Lb& Es SAS.1 <br /> PHONE(7,Qj') _%j5-=j FACSIMILE-�c Sal •_ <br /> TENTATIVE*APPOINTMENT DATE5• ®'OS <br /> TIME <br /> 1 O= M <br /> (Please give 7 to 10 business from of applleadon submittal MAY <br /> CHECK BOX TO EXPED&E REQUEST• 89.10 FEE-REQU ED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT L`,) DATE •®,••M:: <br /> �•�-- .,ems <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> _1331 iV 5• Qt 2t7s, <br /> v w <br /> HAMMEiz 10— <br /> 1_N w <br /> W ME <br /> T\ MMM04L <br /> 40 -imp <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> IS UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> il< OTHER CLEANUP StrE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 9L UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> M HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELfHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING t7 POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER E SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checidn <br /> the appropriate box(es). At least one file UST be selected. Fax to(2091454-0138 or mail to the <br /> agdress indled above. <br /> 2. EHD will notify the applicant if any EHD fi 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 new <br /> application may be submitted when the file is available. <br /> d. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$89.00 deposit prior to review. <br /> S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 5. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT.DATE TIME <br /> DATE:CONFIRMED PHONE FAX INITIALS <br /> R 14WED. YES NO RE MEW DATE <br /> EHD 46412.06 <br /> 3!201202 <br />