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10%04/2002 11:12 209-579-2225 MODESTO ATC PAGE 01 <br /> t Xo SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> o 304 EAST WEBER AVENUE,THIRD FLOOR /O <br /> STOCKTON CA 95202 <br /> 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT + 1 (I <br /> I..►-, KV�O"ert 9USINESS/AGENCY Tr✓ <br /> ADDRESS T I(� L 0,W P �w, Ave ,-�� -9No/die -�c� 0-- <br /> PHONE. �ZOQ S9" ZZZ [ZO�I � S��f-.Z��Z� - <br /> FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE" UZ TH <br /> (Please pi a 7 la So business a s Ir TIMC �O ISM PERMIT�SERVICES <br /> ' Y date o pplicallon subnuttal) <br /> CHECK BOX TO,EXPEDITE REQUEST- <br /> 0 FEE-REQ S7 Pt�SE N J BUSINESS DAYS <br /> SIGNATURE OF .APPLICANT <br /> DATE /U <- C>2- <br /> FILE <br /> ZFILE ADDRL'-55 THIS SIDE EHD STAFF <br /> UBQI7a e•�eI S.»k� �r��o St.eF.c.eE„,Irtr..li.�s r a <br /> v2f1'3555g3 TSES�e/f t G:d�r- <br /> SA. <br /> sc h <br /> ✓ <br /> - <br /> USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> E <br /> M.r s 311$ <br /> 5fc o- y S c c <br /> S O TV-1-9 <br /> 23 <br /> 5W <br /> ws H Q `Tva ✓ <br /> 'r ✓ ., 425 �a 1? Trac <br /> 303 TO Trc 8 S. T✓o, <br /> lo,r`r Trot kir• 3 � j �;� <br /> Tr +tip � �5 �► �r v.s. T•� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(VST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL 0 SOLID WASTE VEHICLE <br /> 0 HAZARDOUS WASTE GENERATOR0 DAIRY <br /> 0 TIERED PERMITT-D FACILITY CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TATTOO/BODY PW0 IRC►NG 0 lA07EUHOTEL O PUMPER TRUCK/YARD/CHEM TOILETS <br /> O MEDICAL WA5-re FACILITY 0 POOUSPA ❑ LAND USE APPLICATION SITES <br /> O PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to.ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fix to 209 4G4-0138 or mail to the <br /> acidress indicated above <br /> 2. EHD will notify the applicant if any EHD 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 <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 /> 4• Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> 5• <br /> of the applicant. Future file reviews by the same applicant may require a $07.00 deposit prior to review. <br /> "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6• Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE <br /> TIME <br /> DATE CONFIRMED PHONE <br /> FAX INITIALS <br /> RREVIEWED YES NO —�- <br /> - oo a uo�roo REVIEW DATE <br /> d <br />