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AUG -29-2003 FRI 10:29 AM S -PORTLAND FAX NO. 50? -7074 _ P, 02/02 Y 08/29/2003 18:25 454 Lrrvim .rvIa� I v iiSy 7 1 `I� Sa►x,To�► un�r COUNTY 4OG NU AUG 2 9 2QQ3 I E 304 Weber A-ve NwNTAL¢ Floor Stockton, AL CA s2N osM (209) 468. 420 Fax(209) 464-0138 Web: www.ca.san-jaa3quin.cg.us/chd EWIRWIINMENT HEALTH 1460 RERMIT/SF,RVjCFS PUBLTC RECO RELEASE APPLYCAUON APPLICANT• 8UE3ENaeStAOt;NCYe _� � I it -f_ ADDRESS ti PHONE:FAC3IEIIILi: 7 i kv��rrt ' - { S �' p pC i vt w p01 ENT DATE: Tom*. (Please anew to huAimaa da" from date of appiitation awbmthw) I HECK BOX TO axreARE REQUEST. —R1:4U oCAa 3 BU81W;83 oA7E SIC3IVATURE OF APPLICANT DATE J ENVIRONMENTAL HEALTH I)EPARTMENT FILES C UNOER®ROUND TANK (US CLEANUP WE" (LOP) ¢� OTHER CLEMUr srM (H0r4-LOP) '5k UNDCRpRvuND TANK (MONIMRINGMEMOVALJ XMAZARDOUs WAVI ORNIRATOR M TIERED PE:RMMD FACIE_* ❑ TArrow oDy PIERCINn = mmcALwAsTE rACILrry f UNFT 0 Unit 4 2 P Unit Unit 4 ��-- 0 Unit 5 IJ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY 0 ROOD FACILM ❑ SOLM WASTE VMICLE: ❑ Ct ❑ G C1 HICKZIN RACH ❑ rKG TR EITXENTii1NT ❑ MOT ELI"OM a PUMPIR rniJCWARMHEM TGILCTS © POOLISPA CI LAND USE APPLICATION GRES ❑ MER (PLPASE SPECIFY)- 1. 1_E3t up to ten addresses In the apace aborta. select the type(s) of files from the list aboys �y checking the appropriate 16ox(es). At least ono file typo MUST bo salected. ll e wress Indicak d above. 2. EHD will notify the applleant if eny EHD files exist. An appointment for reW41W will be confirmed approximately fl * bu=innAs days but no later than tan (10) days affect receipt of application. The files will be hold for 4 maximum of five business clays for review. Appointments should be scheduled acoordingty. 3. A file that Is AGt�ely being worked on by EHD staff may not be immediately "lable for review. A now appilesation mai lbo submitted when the f{io is slv*llabIn. 4. Any file not roto ned In the same Cvnditivn as rola#sed will be revrganizod by l=HD staff at the expense of the applicant' Future file reviews by the same applicant may require a i.23.00 daposit prior to review, 3. 'TENTATIVE= appointment dates must be confirmed with EHD staff. 0. Applications reIeived after 3:00 pm will be processed the next businosa duly. CONFIRMED AF+POINTMENT DATlw — TIME, DATE CONFIRMED PHONE . FAX INIT l a .2110 REVIEWED YES NO REVIEW DATE Sam*] o • & ' R" -2lriwK� ..,.. nT�uT11�U�C■�7i�C■lti� ENVIRONMENTAL HEALTH I)EPARTMENT FILES C UNOER®ROUND TANK (US CLEANUP WE" (LOP) ¢� OTHER CLEMUr srM (H0r4-LOP) '5k UNDCRpRvuND TANK (MONIMRINGMEMOVALJ XMAZARDOUs WAVI ORNIRATOR M TIERED PE:RMMD FACIE_* ❑ TArrow oDy PIERCINn = mmcALwAsTE rACILrry f UNFT 0 Unit 4 2 P Unit Unit 4 ��-- 0 Unit 5 IJ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY 0 ROOD FACILM ❑ SOLM WASTE VMICLE: ❑ Ct ❑ G C1 HICKZIN RACH ❑ rKG TR EITXENTii1NT ❑ MOT ELI"OM a PUMPIR rniJCWARMHEM TGILCTS © POOLISPA CI LAND USE APPLICATION GRES ❑ MER (PLPASE SPECIFY)- 1. 1_E3t up to ten addresses In the apace aborta. select the type(s) of files from the list aboys �y checking the appropriate 16ox(es). At least ono file typo MUST bo salected. ll e wress Indicak d above. 2. EHD will notify the applleant if eny EHD files exist. An appointment for reW41W will be confirmed approximately fl * bu=innAs days but no later than tan (10) days affect receipt of application. The files will be hold for 4 maximum of five business clays for review. Appointments should be scheduled acoordingty. 3. A file that Is AGt�ely being worked on by EHD staff may not be immediately "lable for review. A now appilesation mai lbo submitted when the f{io is slv*llabIn. 4. Any file not roto ned In the same Cvnditivn as rola#sed will be revrganizod by l=HD staff at the expense of the applicant' Future file reviews by the same applicant may require a i.23.00 daposit prior to review, 3. 'TENTATIVE= appointment dates must be confirmed with EHD staff. 0. Applications reIeived after 3:00 pm will be processed the next businosa duly. CONFIRMED AF+POINTMENT DATlw — TIME, DATE CONFIRMED PHONE . FAX INIT l a .2110 REVIEWED YES NO REVIEW DATE Sam*]