Laserfiche WebLink
06/13/2006 14:56 FAX I�001/001 <br />Gh.i •vJ . r .�u <br />PA ~= RECENEP .SAI JOAQUE'j C0UNTY <br />EryV'Ron11ENTALREALTT3�Fpp.FCTlY1E^IT <br />(�` L II��� apo F Weber Ave 3'" Floor Stockton, CAo 5 U S <br />111 ca lts/e�Zc �� U (YJ <br />f209) 408 3420 Fax: (?_()g) 454-0138 Web: <br />i iv t 3 [006 PUSI iC RECORDS RELEASE APPLICATION <br />—�� <br />PEPR411:!S'��t Ei.. BUSINESSJAGENCY:_y�=?� <br />APPUCANT:T I ~• <br />aDQREss: <br />FACSIMILE: <br />PHONE: <br />TENTATIVE APPOINTMENT DATE: <br />(Plea.* allow 10 basis day= from date of 41PPlicatlon submittal) <br />CHECK £OY. TO FJtP£DfTE REQUEST - 501.00 FEE- . QUEST PROCESSED W 1 BUSINESS DAYp ATE (� l rZ <br />f. <br />siGNATURE OF APPLICANT <br />ENVIRONMENTAL HEALTH DEPA"IN' cr+I c ." - <br />5LSOLID WAST-- FAGILrrY <br />CJ SOLID W AS -i= VEH%C E <br />G. DAIRY <br />I3-PKG TREATMr ST PLANT <br />❑ PUMPER TRUCKrYARDlCHEMTOILETS <br />III LAND US`c APPLICATION SrMS <br />L)eoann•'anl Use Only <br />UMT <br />0 Unit 1 <br />oy Unit 2 <br />04eunit 3 <br />�,/ YX1 UniS, 4 <br />C7 Unit s <br />UNDERGROUND TANK (U5T7 -Lemup SrrE (LOP) <br />❑ HOUSING ABATEMENT <br />O FOOD FA.GILrrY <br />02 OTHER GLeMUP 4(T (NON -LOP)❑ <br />TANK (MQNITORING1REMOVA4) <br />DOG KENNEL <br />❑ CHICKEN RANCH <br />F} UNDERGROUND <br />Z Wa',RDOUS WAZTE GENERATOR <br />❑ MoTEUHOTEL <br />❑ 'r1ERED PERMrTTED FACILITY <br />❑ POOLfSpA <br />R TATTOOBOQY PIcRCING <br />❑ OTHER (PLEASE SPEC <br />5 <br />0 MCDIC:rLWASTE FACILITYthe list a6aye?Y c hecking <br />t List up to ten addresses in the space above, Select the t'/Pe(s)e(s) of III" <br />from box(es), At least One file type MUST be :ejected, Fez to My) <br />@Te: appropriate 4lvt-0138 nr m%til to the <br />address ind ted abP ve. ointment for review will bacon firmed <br />2. <br />EHO will notify <br />the plieant if any EHD files exist to appointment <br />fer recei t Of application. The fdas <br />s for review. Appeinimenis should be scheduled <br />approximately five business days but no later than ten (10) days <br />will he held for a maximum of five business day <br />accordingly -not be immediately available for renew- A new <br />3 A file that is actively being worked on by EHD staff may <br />application maybe submitted when the File is readable' require a $g3.00 deposit prior to review. <br />q Any fife not returned in the came condition i s released will be reorganized by EHD staff at the expense <br />of the applicant. Future nle reviews by the same applicant may -9 <br />6.ENTATNE appointment dates must be confirmed with EHD staff, <br />received after 3:00 Pm will be processed the next business day. <br />g Applications f <br />TIME <br />��NF1PM�f1•E1P.?OINTMEhI7"DATE' ::..'gFiN 11AL-S <br />FAX <br />DATEGQHr1RN1ED .. . . <br />NO <br />REVIEW BATF <br />REVIEWED yes ....O------- - - <br />