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;------r%p-I1-03 13:43 From-TTI TETRA TF t( INC +9168520307 T-507 P.02/03 F-803 <br /> hSAN JOAQuIN COIJNTYPllB1.iCHEAt.TH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> SEP 11 2003 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95201 <br /> ENVIRONMENT HEALTH (209) 458-3424 <br /> E %11T/SERVICES PUBLIC RE:CORUS RELEASE APPLICATION <br /> /� rd h 5htsa(meq h <br /> APPLICANT �C� <br /> ADDRESS /06 ppD Y/Itc 0 r00 �a�nc.{�o eorcloua� GR- 9SbT <br /> PHONE SJ��- S..�O FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE \ TIME Nri l iVIA <br /> ' (PI¢asc yiv¢7 w 7¢puniness pays paiC pF appheaGon aunmittat) <br /> r A� lk <br /> PE <br /> X CHECK BOX TO EXDITE IREQUE SC7.oa FEE-RE ST PROCESSED IN 3 BUSINE55 DAYS <br /> SIGNATUREOFAPPLICANT l /) �— �� DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF PSE ONLY <br /> PROGRAM ELEMENTSSFARCH <br /> 017 aj@A 4K <br /> (-I r <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNPEftGROUND TANK(UST)CLEANUP 517E(LOP) ❑ HDUStNG ABATEMENT SOLID W T <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) O DOG KENNFL DAIRY <br /> HAZARDOUS WASTE GENEPAATOR 0 CHICKEN RANCH 0'PKC TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOTEL/HOTEL 0 rUMPERTRUCK)TARDICHEMTOILET: <br /> ❑ TATTOOIBODY PEIRCINO 0 POOU5PA 0 LAND 115E APPLICATIQN Sn ES <br /> • MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM Q OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) off lies from the list.above by checXil <br /> the appropriate Pox(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail Toth -rt) <br /> pdress indicated above. n <br /> 2. EHD will notify tf a applicant if any EMD 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 file <br /> will be held for almaximum of five business days for review. Appointments should tie scheduled <br /> accordingly. <br /> 3. A file that is actively Poing worKed on by EHD Staff may not be immediately available for review. A n <br /> appiication may be,submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by END staff at the expen <br /> of the applicant. Future file reviews by the same applicant may require a $57.00 deposit prior to revi, <br /> 5. vTENTATIVE appointment dates must be confirmed with EHD staff. <br /> 5. Applications received after 5:00 pm will be processed the next business day. <br /> 71 <br /> CONFIRMEQ APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> Pr3 <br />