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06/27/2005 11:35 FAX 209 948062" 11002/002 <br />DATE RECEIVED SAN JOAQUYN COUNTY ' <br />HEr <br />ENYVMONMENxAL HEALTH DEPA,E.TMENJ. 304 E Weber P Floor Stockton, CA 95205 <br />�� . 1? 372, <br />4 � 1(709468-3420 Fax: (209) 464-0) 38 Web: www.co.san joaquin.ca.us/ehd <br />Et�ViRONR �t�l {EALTK PUBLIC CARDS -RELEASE APPLICATION <br />BUSINESSIAGENGY: <br />APPLICANT; roc► <br />TENTATIVE' Appowmwr DATE: V1 b Time: <br />(Pleasc allow 10 business days from date of aPPliGit{o(1 s4bmittel) <br />CHECK BOX TO ExpEorrE REQUEST - 590.00 FEE— RF -QUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT /7�y�'�+ DATE i <br />' l]ep ttmant Use Only <br />-ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />U NIr <br />Unit 1 <br />40<U nit 2 <br />Unit 3 <br />Unit 4 <br />a ynit 5 <br />vn$ � <br />UNDERGROUND YANK (UST) CLEANUP SrM (LOP) <br />Cl HOUSING ABATEMENT <br />❑ FOOD rY <br />RL SCUD WASTE FACIt -Ty <br />ClSOIJO WASTE VEHICLE <br />OTHER CLEANUP SITE (NON -LOP) <br />a UNDERGROUND TANK (MONITORINGIReMOVAL) <br />❑ DOG KENNEL <br />ENNE <br />pAIRY 1 <br />0- PKG TREATMENT PLANT <br />"0 <br />16 HA,ZARDbiUs WA5TE GENERATOR <br />� <br />❑ T)ERI=D PERMED FACILITYfl <br />❑ maRANCH <br />Q MOTELIHM07EL <br />TE <br />P�j�PA <br />❑ PUMpERTRUCKlYARO/CHEM TOILETS <br />M LAND InE APPUCA-noN srms <br />❑ TATTOOMODY PIERCING <br />I7 OTHER (PLEASE SPECI <br />y. , - <br />InMEDICAL WASP` FACILfTY <br />NO <br />REVIEW DATE' <br />7, List up to ten addresses. in the space above. Select the type(s) of files from the list above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the <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 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 EHD staff may not be immediately available for review. A-ne' <br />application may be submitted when the file is available. at the expens - <br />4, Any file not returned in the same Condition as released will be reorganized by EHD staff <br />of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to revie <br />5. gENTATIVE appointment dates must be confirmed with EHO staff. <br />g. Applicatloris received after 3:00 pm will be processed the next business day. <br />I..... <br />o(NTiuI'�ivs:aa:TE: <br />--TIME :; �.�,;;.�;; <br />'���;._�; <br />COj`1F:� RM <br />FAX-': - • NFr]Q1=S <br />IpATE.CQNFIR MED <br />y. , - <br />I YES <br />NO <br />REVIEW DATE' <br />REVIEVlED <br />