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09/19/2002 16:03 2079-2225 MODESTO A o PAGE F <br /> y <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES � fL <br /> ENVIRONMENTAL HEALTH DIVISION <br /> O� oo <br /> 304E ST WE6ER AVENUE,THIRD FLOORD �� Jl <br /> I O STOCKTON CA 25202 r <br /> (200) 4611•3420 <br /> _ <br /> PUBLIC RECORDS RELEASE APPLICATION qp 1 9 2002 <br /> APPLICANT Skt/ /\/P _ BUSINCSSIAGENCY_14TG 14.1'56a1.4 f4& nRNNMENTTHE,ALTH <br /> ADDRESS ///7\ )_oAj& PALpv%A v6 'Buhr= ,8 a ?Mpesm� C.4 <br /> PHONE J 5 / / —ZZ.Z FACSIMILE Cwq) 5 7g-- <br /> TENTATIVE-APPOINTMENTDATE" / TIME IO dfiN,. <br /> (Please Dive 7 to10 Nbu'zm days fro dale of appl' atlon aubmiUal) <br /> CHECK BOX TO,CXPEDRE R£QUES7- �FCE-RE UE f RO D IUSIN£55 BAYS <br /> SIGNATURE OF APPLICANT DATE 09 l9 L <br /> DDRESS THIS SIDE E•HD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> U.jW1, <br /> � <br /> 7 L N Vr,At AW ITU <br /> MI <br /> LOA <br /> 0 <br /> U <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONTTORINGIREMOVAL) O DOG KENNEL O DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANY <br /> ❑ TIERED PERM177CO FACILITY O PAOTEIHOTEL O PUMPER TRVCKIYARDICHEM TOILETS <br /> O TATTOOIBODY PBIRCING 0 POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTI`FACILITY O PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ADOVE) <br /> 1. List Up to tcn 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).464-0138 or mail to the <br /> 'addressIndicatedabove. <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 stuff may not be immediately available for review. A now <br /> application may be submitted when the file is available. <br /> 4. Any (Ile not returned in the same condition as released will be roorganizod by EHO staff at the expenso <br /> of the applicant. Future file reviews by the same applicant may require a $87.00 deposit prior to review. <br /> 5, 'TENTATIVE appointment dales 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 TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> RF-VIEWED YES NO REVIEW DATE _ <br /> FM1 00 f. Ou01PoY _. <br />