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Avr. 26, 2005 2:06PM ADV `ED GEO No. 0333 P. 1 <br /> DATE RECEIVEDSAN TOA�t COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT 115lq <br /> 3041?Weber Ave 3'd Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd 2005 APR 26 <br /> P LIC RECNTY <br /> ORDS RELEASE APPLICATION <br /> PH '3i 33 <br /> APPLICANT: �. �� 7 1 cy7�,,USINESsIAGENCY: aduarleej �Qi f V s Q(L <br /> ADDRESS: 932 &Aa/� I_�yUJ d �71t/C 1.I7A 1 a-a) � HFNT <br /> PHONE: 940- y(P /' 1,6611 FACSIMILE: D7 � 7-///00 <br /> � <br /> TENTATIVE`APPOINTMENT DATE: �Tbrp: D or Wh <br /> , ��'�7 <br /> (Please allow 10 bd ineso days from dam uf application <br /> CHECK BOX TO EXPEDITE RE q 3T- 93.ee FEE-RE T PRO ESSED IN 3 BUSINESS DAYS /J <br /> SIGNATURE OF APPLICANT DATE * � Oyr— <br /> Department Use Only <br /> US'f �a <br /> FILE ADDRESS UNIT <br /> / soen <br /> QST !dw z. so-en � / • C �� a ❑ Unit 1 <br /> 9. Seem p O <br /> k BtleM 2 ,1 •l/,/(f�la/ <br /> 6. weal Uni VI <br /> e. 6sexnit 4 <br /> oty <br /> - <br /> p Unit 5 <br /> fo, sv6� I <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT ❑ SOLID WASTE FACII®Y� <br /> OTHER CLEANUP SITE(NON-LOP) D FOOD FACILITY O SOLID WASTE VEHIECE US <br /> UNDERGROUND TANK(MONITORINGIVEMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH M PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ POOLISPATEL 13 PUMPER TRUCKICATION SIT TOILETS <br /> � TATTOOIBObY PIERCING O pOOLISPA 13 LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the typs(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 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 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$93.00 deposit prior to review, <br /> S. "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 /> CONPIRMED APPOINTMENT PATE 71WIE <br /> DATE CONFIRMED PHONE FAX INITIALS . <br /> REVIEWED YES NO REVIEW DATE <br /> rmD eem as <br /> ertrsosa <br />