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209-579-2225 MODESTO ATC . PAGE 01 <br /> SAN JOAQUIN COUNTY erto`oca NUMBER. <br /> SEP 0 4 2003 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EAST WEBER AVENUE,THiRD FLOOR <br /> :_:NV!RONMENT HEALDil STOCKTON CA 95202 <br /> PE Ri04T%SERVICES (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT `a` Mull., BU$INES&AGE,NCY A C(' <br /> ADDRESS <br /> PHONE�1._t t " Z���-1 FACSIMILE <br /> TENTATIVE"APPOINTMENT.DATE_ Thnk `Z!r 'C13 TIME (jam <br /> (Please give f to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 F E-REQUEST PROCESSED IN 3 BUSINESS-DAYS <br /> SIGNATURE OF APPLICANT � "�C�tA� - DATE q�31'43 <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY 7,0 <br /> \J PROGRAM ELEMENTS SEARCH <br /> Z3� p ±f. <br /> 7-L( %� <br /> V x:q LQ C-Vt'­k T %;a k v <br /> L.')"--r 7,0 Svc <br /> Lk— t,514, TeG�' 14 <br /> 3 d Ma.-(-t.� <br /> '41t k ).)Ov <br /> �_�N[VIRONiMENTAL HEALTH DIVISION FILE <br /> V UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 13 SOLID WASTE FACILITY <br /> 13 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL a DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKNARD/CHEM TOILETS <br /> Q TATTOO/BODY PEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY M OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the apace 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. Fax to(202) 464-0138 or maJI to the <br /> addresglndicated a ove. <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 /> of the applicant. Future file reviews by the same applicant may require a$89.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with END staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> S. <br /> D F.CGIM,pAgq PHONE -AW :..:' TIALS <br /> ..�..._ <br /> tZEV� YE$ NO Vhk1317 <br /> 11 5 earn <br /> � wit <br /> ho x. -I e,,�w <br />