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n <br /> ' 08/28/2002 16:53 20'3^q9-2225 MODESTO ATC,r PAGE 01 <br /> SAN-JOAQUIN COUNTYPUBLIC HEALTH SERV(C <br /> ENVIRONMENTAL HEALTH DIVISION �j <br /> MCD <br /> 304 EAST WE13ER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468.3ds0 AUG 2 9 2002 <br /> _ PUBLIC RECORDS RE[.EASE AAF'PLIGATION <br /> APPLICANT irt� "C C + 1 <br /> EUSINESSIAGENCY VICES <br /> ADDRESS �.'QtiIV� �G�WI , -1 J1V r 5�]: itA <br /> PHONE ' - Z ZZ I FACSIMILE 4Q 5 7-2'L 5— <br /> TENTATIVE"APPOINTMENT DATE IN ' <br /> TIME <br /> (PICxsa VIVO 7 to 40 buaiileSs da S from' (a of pppiiestlon sui�lnillal) <br /> ED <br /> CHECK BOX TO,Ii?CPED{TE Rf~QUCS1 -$07.00 FC -STPRO �SSED iN S BUSINESS DAYS <br /> SIGNATURE" OF,APPLICANT �Nw/ �'� N"�--- DATE `6, Zv d� <br /> FILE AOORL=SS THIS SIDE r--HD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> I 13 1Np.,� Reae,d► S�tK{��► <br /> t-Z 7smiL <br /> 1 <br /> z-S t,J. IJPS; k0a Ali <br /> a s1�. 4-0�• s _ <br /> IZ <br /> q O <br /> ENVIRONMENTAL HEALTH DIVISION FILES `A <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 souo wA5TE FACILITY <br /> 1 OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> O UNDERGROUND TANK(MONITORING/REMOVAL) © DOG KENNEL 0 DAIRY <br /> 0 HAZARDOU5 WASTE GENERATOR 0 CHICKEN RANCH 0 PKrx TREATMENT PLANT <br /> ❑ TIERED PERMITT D FACILITY ❑ MOTELIHOTEL 0 PUMPER TRUCIVYARDICHEM TOILETS <br /> 0 TATTOO113ODY P9IRCING M POOVSPA 0 LAND UsE APPLICATION srrEs <br /> 0 MEOICAL WAS-rd FAC11_1TY 0 PUESLIC WATER SYSTEM 0 OTHER(PLEASE~SPECIFY AtIOVEc) <br /> 1. List up to ton addresses in the space above. Sulectl the type(s) of files from the list ab ova by chocking <br /> the appropriate: box(cs). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the <br /> address 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 torr(10) days after receipt of application. The files � <br /> will be held for a maximum of five business days for review. Appointments should ba scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. Anew � <br /> application may be submitted when the file Is availaIe. <br /> 4. Any file not returned in the same condition as rcloatd will be reorganized by EHD staff at the expense <br /> Of tl10 applicant. Future file reviews by the same applicant May require a $137,00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed Ir Ith EHD staff. <br /> 6. 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 /> REVIEWED YES NO REVIEW DATE <br /> ah 00 14 f40 <br />