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10/04/2002 11:12 209-579-2225 MODESTO ATC PAGE 01 <br /> ... ._ .. .... SAN .10gQUIN C <br /> j0X0 <br /> OUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION " <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 05202 �O <br /> (2Q`�) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT w� K Qrt <br /> HU51NES5lAGiNCY TG o�iw�Gr [R�_T4 f L DJADDRESS I t p Iw, � � � ci <br /> PHONE oa -- Zz 2 lZv�l ) S�j 2.Z' <br /> . FACSIMILl3 <br /> TENTATIVE"APPOINTMC14T DATE f c) TH � <br /> (P,aasc iTIME !D PfiRMfT/SE VICES <br /> WO <br /> J,!0 Uwiness ys!r dale o pplleatlon:u6i�illal) yy <br /> . . I <br /> CHOCK BOX TO,EXPEDITE REQUEST- �REQ 5T P <br /> t SE N J BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> ' DATE= <br /> FILE ADDRESS 55 THIS SIDE END STAFF Ust:ONLY <br /> ~ PROGRAM ELEMENTS SEARCH <br /> 5 ' I Es <br /> o p�+.»s 5�5 SCc�'eti. v S is ✓ <br /> CCti r✓ S o TYa< ; ' <br /> T <br /> -t ✓ w 4e�5 �q � Trac i <br /> 12350 <br /> it Trutki•+ 3� L;,, <br /> Soo <br /> 7 H ,,w s. T { <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING A13ATEMLNT O SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NOH-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VLHICLC <br /> UNDERGROUND TANK(MONiTORINGIREMOVALI ❑ DOG KENNEL Q DAIRY <br /> ❑ HAZARDOUS WASTE GENCRATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 0 TIERED PERNNTT4-D FACILITY d MOTEL11;OTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIJIRCING ❑ POOLJSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL wASTi FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPLCIFY ADOVL) <br /> 1. List up to.ten addresses in the space above. Select the typp(s) of files from the list above by checking <br /> tna appropriate box(cs). At!cast one file type MUST be selected. Fax to 209 464-0138 or mail to the <br /> address.'indicated bove. ---- <br /> 2. EHD will notify the applicant if any EMD files 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 f <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 lmrnediately available for review. A new <br /> application may be submitted when the file is available. <br /> a. Any file'not returned in the same condition as released will be reorganized by EHD staff atthe e <br /> of the apxperlsc <br /> applicant. Future file reviews by the same applicant may require a$07.00 deposit prior to review. <br /> S. "TENTATIVE appointment datos must be confirmed with EHD staff. <br /> 0. Applications received atter 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED <br /> PHONE FAX <br /> INITIALS <br /> REVIEWED <br /> EM 00 a W loo YES NO REVIEW DATE _ <br /> s '� <br />