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MAY 18 2004— 2.08PM`J0Y" MERY WATSON NO.923EHDLp, 1UMBER <br />DATE RECEIVED WSAN JOA.QtA.N COUNTY a <br />''� r= ''J �i��,�i <br />I°�S� ��", I,�, I � �;� � �� �+ NVIRONME1vTAL FIEALTT� DEPARTMENT <br />304 E Weber Ave 3`d Floor Stockton, CA 95205 <br />M Ry 18 2669) 468-3420 Fal- (209) 464-0138 Web. www.co.San joagUin.Ca.us/ehd I <br />�VIhJPdMENT HEALTH PUBLIC CORDS RELEASE APPLICATION <br />l�C`;r.lt Tl. l W <br />AppLICAN7:-��r BUSINESS /AGENCY: <br />ADDRESS: �' �' �'-�^'_`'JVS LOv'"✓`"- O may' L-71; <br />PHONE: (q/ G) Z.r?' q,9q FACSIMILE: <br />^�r�r <br />TENTATIVE" APPOINTMENT DATE: Time: _ <br />0A <br />(Please allow 10 business days from date of appnr tion submittal <br />CHECK BOX TO EXPEDITE REQUEST - $93 00 FEE- REQUEST PROCESSED IN 3 BUSINESS DAYS / <br />DATE <br />SIGNATURE OF APPLICANT Depanm nt Use only <br />r- UNIT to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />$( UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />13 HOUSING ABATEMENT <br />■Unit 2 <br />i:. <br />171 FOOD FACILITY <br />❑DOG KENNEL <br />171' DAIRY <br />❑ PKG TREATMENT PLANT <br />J9_ HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ CHICKMOTELEN RAN <br />MF �MLT,w <br />ID TIERED PERMITTED FACILITY <br />❑ POOLISPA <br />❑LAND USE APPLICATION SITES <br />$( UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />13 HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITY <br />13 SOLID WASTE VEHICLE <br />❑ OTHER CLEANUP SITE (NON -LOP) <br />9 UNDERGROUND TANK (MONITORINGlREMOVAL) <br />171 FOOD FACILITY <br />❑DOG KENNEL <br />171' DAIRY <br />❑ PKG TREATMENT PLANT <br />J9_ HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ CHICKMOTELEN RAN <br />❑ PUMPER TRUCK/YARDICHEM TOILETS <br />ID TIERED PERMITTED FACILITY <br />❑ POOLISPA <br />❑LAND USE APPLICATION SITES <br />❑ TAT700BODY PIERCING <br />❑ MEDICAL WASTE FACILITY <br />❑OTHER (PLEASE SPECIFIC <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 (2091464 0138or mail to the <br />address indicated above. ointment for review will be confirmed <br />2. EHD will notify theapplicant if any EHD files exist. to app <br />approximately five business days but no later than ten (10) days oftntmeer nts shou d be stched lu eafiles <br />will be held for a maximum of five business days for review. App <br />accordingly. <br />3. A file that is actively being worked on by EHD staff may not be immediately available for review. A neu <br />application may b®submitted when the file is available.at the <br />be 4. Any file not returned in the same wndition as releas;dc nt may requireza $93. 0 ded by Deposit prior to evieµ <br />of the applicant. Future file neviews by the same app <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 />`�N ►���' 7?Pga�T>�p�f a�,aT� c� � �,;,,, Ar ' ��,�, . , ��-�,Trl r:. . `` ,., '. n' r ; ' _., AY• �.. <br />CONFIFtilEp PRUNE <br />R)x11�Elti1 <br />YES ..r. Nb <br />