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Apr•27. 2004 1:05PM Ne&• Anderson & Assoc. <br />DEP <br />NTY i No -4929 ETP• 2"aub115i <br />V DATE Kl�mlvnu JAN JOAQUIN t.,O DEPARTMENT <br />ENVIRONMENTAL HEALTH <br /><J 34WebeAoor StocktonanAdWso q in ca.us/ehd <br />-0138 Web:v`co <br />D(209) 468-3420 Fax: (209) 464 I <br />PPR 2 12004 CORDS RELEASE APPLICATION <br />BLICRI + RSsac. <br />s <br />Bus NESSIAGENCY: <br />__-- <br />C7 0 ADDRESS: 2 FACSIMILE: 31Il� pp�� <br />PHONE: 31D? - 3 � ( q d e 11e'! • <br />Time: <br />TENTATIVE" APPOINTMENT DATE: lication submittal) <br />(Please allow 10 business days from date of app <br />K BOX TO EXPEDITE REQUEST - $93.00 FEE - REQUEST PROCESSED IN 3 BUSINESS DAYS tf 72' b <br />DAT <br />CHEC <br />SIC""T"oc nF APPLICANT <br />Department Use OnlY <br />Unit 1 <br />p Unit 2 <br />Unit 3 <br />Unit 4 <br />Unit 5 <br />ENVIRONMENTAL nrs "' - ❑ SOLID WASTE FACILITY <br />CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE VEHICLE <br />4A UNDERGROUND TANK (UST) (3 FOOD FACILITY ❑ DAIRY <br />I OTHER CLEANUP SITE (NON -LOP) ❑ DOG KENNEL ❑ PKG TREATMENT PLANT <br />HEM TOILET14 . <br />UNDERGROUND TANK (M [3 CHICKEN RANCH ❑ pUMPERTRUCKJYARDIC <br />HAZARDOUS WASTE GENERATOERATOR INGIREMOVAL) ClMOTEUHOTEL ❑ LAND USE APPLICATION SITES . TIERED PERMITTED FACILITY ❑ POOVSPA <br />❑ OTHER (PLEASE SPECIFY) <br />❑ TATTOO/BODY PIERCING CheCklt <br />C3 MEDICALWASTE FACILITY - of files from the list above by <br />List up to ten addresses in the sace above. Select thetype(S) <br />1• es At least opne fete type MUST be selected. Fax to 209 464-0138 or mail to th� <br />the appropriate box( ) <br />address indicated above. ointment for review will b;lca Ion The file <br />EHD will notify the applicant if any EHD files exist. to app days after receipt of app <br />2. y s but no later an ten (10) y ointments should be scheduled <br />approximate) five business day <br />will be held for a maximum of five business da s for rey not be immediately available for review. A r <br />accordingly. worked on by END staff may <br />g A file that is actively being <br />application may be submitted when the five is availabl,d will be e. require a $93.00 deposit prior to rev <br />4 Any file not returned in the same conditthe same applicant Mayyeorryganized by EHD staff at the exp <br />ei <br />of the applicant. Future file reviews by <br />appointment dates <br />5 'TENTATIVE must be constaff - <br />fi processed the next ith business day. <br />6 Applications received after 3:00 pm will be p <br />TIME <br />GON M D APPOINTMENT DATE PHONE FAX INITIALS ___--- <br />DATE CONFIRMED REVIEW DATE <br />REVIEWED <br />YES NO <br />lIV200a <br />