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11-16-2000 1::21141 FRJ11 TL <br /> w+,4�yMYCY •O <br /> 91(N!a <br /> JA'A'QUIN CggqNTYPUBLIC HEALTH SER IV CES UK `YyhJHH w <br /> ' ` :�NVIRO'NMENTAL HEALTH DIVISION (+�/ <br /> 304 EAST WEBER AVENUE, THIRD FLOOR ;/� t(SH <br /> / <br /> Nov 0 1 2001 STOCKTON CA 95202 <br /> (209)4683420 (, <br /> 7 LOUBL1C .REWIRPS RELEASE APPLICATION 7 <br /> APPIICANT'' ,,..t,, rE��LNMK BUSINESS/AGENCY CONDa9t- CARMICL4N OC.OGr6 S• <br /> ADCRESSQD i-KkWEST C(p;�„s. A <br /> yaa <br /> Tam- N . �+ � SLOIo <br /> PHONE �•3LI_ 9S'l g FACSIMILE 23r( — OS38 <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please give 7`lo'I0 busmeas tlSiys f�o3tlato of a pgcallon submittal) 1 <br /> CHECK BOX TO EXPEDITE REQUEST•$9T. FE�EQUESi PROCESSED ?BUSINESS GAYS I <br /> SIGNATURE OF APPLICANT DATE I al <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> ntl. <br /> ro.do <br /> I)or--t <br /> r <br /> oTaa(o <br /> 1O-4 E. <br /> 125 It . Gt=lor^a. <br /> tJO� ly. `1 vC'Y0. O <br /> foo N. Et w.ol.c <br /> o f�• E 1 Drr o _Ot,.+F }, <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(VST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT L3 SOUO WASTE FACWTY <br /> > `OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL O DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOTEVHOTEL O PUMPER TRUCKn'ARDlCHEM TOILETS <br /> 19 0 TATTOOLBOGY pE FACILITY <br /> 0 POOIISPA Cl LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACWTy ❑ PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) . <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list above by checking <br /> the appropriate bOX(es), At least one file type MUST be selected. Fax to (209) 464-0138 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 tiles <br /> will be held for a maximum of five bus(ness days for review. Appointments should be scheduled <br /> accordingly. <br /> _ 3. A file that is actively being worked on by END staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4• Any flie 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 587.00 deposit prior to review. <br /> 5. `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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX <br /> tN171AL5 <br /> REVIEWED <br /> u c rro� YES NOREVIEW DATE <br /> TOTAL P.g2 <br />