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06/14/2005 14:18 20936` -'28 NEIL ANDERSON r- -IIRO PAGE 02/0' <br /> . EHD LOG NUME <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> n(� r',`J]c ENVIRONMENTAL HEALTH DEPARTKENT <br /> H LA ��LI�", =D 304 E Weber Ave P Floor StocktOD, CA 95245 - <br /> (209)468-3420 Fax: (209)464-0138 Web:www.co.sanjoaquin.ca_usJcl�d <br /> �?✓;V � � 7005 <br /> ENVtF;Oivil+r .�,._ PU_BLIC�RDS RELEASE APPLICATION _ <br /> PERMIMSERVICES BUSINESS/AGENCY., AW( C <br /> APPLICANT: <br /> ADDRESS: D `� <br /> PHONE: ,Z <br /> 1 FACSIMILE: ` <br /> TENTATIVE*APPOINTMENT DATE= D Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$ 3.00 FEE EQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE t 05— <br /> Department Use Only <br /> FIDE ADDRESS <br /> UNIT <br /> 7, S k-. G� �� p Unit 1 <br /> 7- Street <br /> 3. Stmrl V • Ct ❑ Unit <br /> 4. S+rmt d <br /> Street at Unit 3 <br /> 5. Simrt <br /> 7. Steeet ct n <br /> 0. Street Gt <br /> S. strMt rat ❑ Unit 5 <br /> 10. Street cl <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT G SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONtTORING/REMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> )!.TIERED PERMITTED FACILITY 0 MOTELMOTEL 0 PUMPER TRUCK/YARDICHEM TOILE <br /> O TATTOO/BODY PIERCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> D MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) --- <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by cheO ) <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to t <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 fi <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A w <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expE e <br /> of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to re* w. <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 INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 40-07.006 <br /> Ne/200� <br />