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Jul 01 04 03: 20p KRF& L ASSOCIATES SlG'jjj 2222 p. 2 <br /> 02/06/2004 12:12 4640136 <br /> EDDSAN JoAQvIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2DO4 1 of <br /> O O 1 304 E Weber Ave 3rd Floor Stockton,CA 95205 �U( <br /> O p ax: (209)464-0138 Web:lww.cO.san-)Daquin.ca.us/chd <br /> l: ,ir iV, D <br /> p"-','AT/SERVICES LIC I2ECORD5 RELEASE APPLICATION <br /> •��A-7 N Ir/ �/ !Y�CCG- �rl �F� <br /> -♦yNzi LL 8usp1E5SIAGENC'r: it _ <br /> EAPPLIDRESN: ' FACSIMILE:ONE: !O <br /> nme: <br /> TENTATIVE'ApMNTMENT DATE: <br /> (Please*pew 10 pwlMsa days em+I date Of aPPlimtlon'Uhml11an <br /> CHECK BOX TO EXPEORl REQUES .0 iE-REQUEST PROCESSED IN 7 BUSINESS DAYS21 <br /> DATE <br /> 4?� UNSIGNATURE OF APPLICANT DeoadmUse Only <br /> vN <br /> IT <br /> FILE ADDRESS � C' <br /> u <br /> G <br /> kwt ❑ mt t <br /> ° <br /> c OF <br /> 11� a s.e„ SSU <br /> Unita <br /> Dt 4 <br /> ' s� ° ❑ Unit 5 <br /> ,. <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> SOLID WASTE FACILITY <br /> 5 CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID LypgTE y£t11CLE <br /> UNDERGROUND <br /> THER CLEANUP SM <br /> (U TI O FOOD FACILITY p DAIRY <br /> OTHER CLEANUP SITE MON{OP) (7 DOG KENNEL <br /> UNDERGROUND TANK(MOKITORINGmEMOVAl) 0 CHICKEN RANCH ❑ pUMpER TTMCNT ARD4C <br /> G TRE <br /> HAZARDOUS WASTE GENERATOR ID MolE1MOTEL ❑ PUMP ERTRUCucARDICHEM TOfLETS <br /> TIERED PERMITTED FACILITY O POOLISPA ❑ LAND USE APPLICATION StiC9 <br /> ❑ TATTOOISOOY PIERCING ❑ OTHER(PLEASE Mr" <br /> ❑ MEDICAL WASTE FACILITYchocking <br /> List up to ten addresses in the space above. Select the ty <br /> LisPe(s)of files from the lint above by <br /> f At least one file type MUST be selected. F to 209 404 138 or mail to t e <br /> the appropriate box(es). <br /> ddress Indicated above. IFIb"Ont for review Will be conflrrood <br /> EMD will notify the applicant if any EHD files exist An apps after receipt of application. The files <br /> 2, Appointments should be scheduled <br /> approximately five business days but no tater U$forerav ew. ApP <br /> will be held for a maximum of"via business days <br /> accordingly- <br /> g ?,fila that is activsly being worked on by EHD staff may not be immediately available for review. new <br /> application may be submitted when the file is available. be require a$93.06 deposit prior to review. <br /> 4 Any file not returned In the same cO by the as a applicant <br /> may req ire A$ 3.EHD stall p the o r encO <br /> ie <br /> of the applicant Future file reviews t e c same SPP <br /> kF7"TENTATIVE appointment dates mus,b illbwnQrmsdedtthe nlext d siness day. <br /> Applicationeelved after 3:00 pPrTIME <br /> DATE PHONE FAX1NrrIAL5 <br /> REy1Eyy DAZE <br /> NO 'I I `5tk O <br /> �i nog <br /> [ryp YAl�i S��(�U � 4wv <br /> WXAI .I l /Vf <br /> e <br /> Itc(Z� as <br />