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FROM : Ground Zero Ana I ys i s j" ] PHONE NO. : 209 838 9883 '-eb. 01 2006 03:05PM PI <br /> DA REC IV!?i7�� EHD LOG NUMBER <br /> l� <br /> , ;, �, � SAN JoAQvzN COUNTY`� <br /> )ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3"1 Floor Stockton,CA 95205 <br /> t (20.9)468-3420 Fax: (209)464-0138 Web:www.co-saa-joaqiun.caus/ehd <br /> l P . ;,,jt;'0 V110ES PUBLIC SCO"S RELEASE APPLICATION � <br /> APPLICA BUSINESSIAGENCY. <br /> f ADDRESS: pj <br /> PHONE:tao d FACSIMII�.£1 <br /> TENTATIVE*APPomrmENT DATE:�D�y I Time:___�,� �-✓k - 1 <br /> f <br /> (Please akw 10 business days from dale of appliewon submMal) <br /> Q CHECK Box TO EXPEDITE RE $93.00 FI —REQUEST PROCESSED IN 3 BUSINESS DAYS i <br /> SIGNATURE OF APPLICANTS DAT <br /> Ea4 I -"I <br /> rtm ' <br /> Depaent Use Only <br /> FILE ADDRESS UNIT <br /> Unit 1 <br /> x sy�o <br /> a. sit <br /> ,. stet El Unit 2 /1 <br /> C Skeet <br /> & street caw <br /> a"'P <br /> L1v: I <br /> r. street � r,Ilt 4 <br /> 4�A. . <br /> a: saranatY _ <br /> s. Simi aty Unit 5 j} <br /> to seen <br /> r <br /> ENVIRONMENTAL HEALTH DEPAnTMENT FILES <br /> i <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) !C HOUSING ABATEMENT. 0 SOLID WASTE FACILITY <br /> OTNER.CLEANUP SITE(HON-Lop) Q FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNlaERGROUND TANK(MONITORINGIREMOVAL) 13 DOG KENNEL O DAIRY <br /> 0 HAZMDOU53NASTE GENERATOR ❑ CHICKEN RANCH 13 PKG TREATMENT PLANT <br /> ❑" TIERED I'MUMTT'ED FACILITY ❑ MOTiLIHOTEL 0 PUMPFR TRUCKIYARDICHEM TOILETS � <br /> ❑ TATTOCMODY PIERCING V ROOLISPA M LAND USE APPLICATION SITES j <br /> 13 NOXCAL WASTE FACILITY t l OTHER(PLEASE SPECT -- <br /> 1. last up to ton addresses In the space above. Select the type(s)of flies from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2041464-0138 or mail to the <br /> address Indicated above. <br /> 2. END 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 Cf application. The files <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 EHO staff may not be immediately available for review. A new <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 expense # <br /> of the apprcant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <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. j <br /> I <br /> CONFIRMM APPOINTMETIT DATE TIME <br /> DA11 CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EM 4M2-M <br /> elanaw . <br /> x <br />