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APR-18-2811 11: 15 RROM:TgWN & COUNTRY 20936958594640138 P.1/1V. <br /> e <br />� DATE RECEIV ``,'±a.. . IED <br /> _ <br /> EHD LOG NUMBER <br /> aftlo" � > S JOAQUIN COUNTY <br /> CSW ,. IRONIVI�, ,ITAL HEALTH DEPARTMENT <br /> n St. Stockton, CA <br /> i A 46 '909 <br /> 3 odTelephone: 8 <br /> tN <br /> PUS RECIDS RELEASE APPLICATION <br /> APPLIICA}NT: �Sr� J I3USiNE3SlAGl=NCY: 7r C 2 S <br /> ADDRESS: ( CITVISTATEIZIP: <br /> PHONE(1];1 PHO,.. (2):2o f- G/ 1 ?�-��FACSIMILE: <br /> TENTATIVE"APPOINT ' `IT DATE: - <br /> ez Time: <br /> (Plata allow tp bust dayt from: of application submittal-•7anISOVe only-must be conflrmad) <br /> ❑CHECK BOX TO EXPEDITE ES 122 -: E(CASH CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT. ; DATE <br /> Electronic Information: ❑ !{Ilan—D rlption: <br /> FiL EHD USE ONLY <br /> street a <br /> $ f:. Herres f. city <br /> 1• t S-� +� Unit f <br /> 2. f <br /> 3. i Unit 2 <br /> 4. <br /> units <br /> S. . <br /> 7• Unit 4 <br /> 1 <br /> IS <br /> SpeplflC Data Range of Information RsR!� r nit B <br /> d: From : i; r to <br /> NVtf�ON AL HEALTH DEPARTMENT FIL:EB <br /> NDERGROUND TANK(UST)CLEANUP SITE OP) OUSING ABATEMENTLIZ)WAS-e FACIL(TYIVEHICLE <br /> ITATT00180DY <br /> THER CLEANUP SITE(NON-t OP) f;f' i FQOD FACILITY ASTE TfRlr <br /> NDERGROUND TANK(MONITORINGIREM. OQQ KENNEL AIRY <br /> AZARDOUS WASTE GENERATOR <br /> 't HICKEN RANCH WASTEWATER TREATMENT PLANT <br /> ERED PERMITTED FACILITY ! Y OTEUHOTEi MPER TRUCKlYAROICHEMICAL TOILETS <br /> PIERCING , QOLISPA <br /> AND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY <br /> �� � OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RiCORD� E A*AILA,., FOR REVIEW: MONDAY-FRIDAY 8:00 AM-S:OOPIII(ExCLUDING HOLIDAYS) <br /> I. LIN,�ii n W ten addrealRes In the t s ebdve. S, 'ct the type(*)of dies from the list above by checking the appropriate <br /> box(es). At least one file type IIr be telacto, 117ax to(2QRI484-4138 or m-11 to the address Indicated above, Address <br /> ranges will not be accepted-for: Itlonal au nce with fife addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed then Usirmos d .y <br /> i ' <br /> 2. the EHD will notify the applicant!I' ny E; D fit' 'Met. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of applicstlon..� a thea will eld for a maximum of five business days for review. Appointments <br /> should be scheduled accordingi .'11 <br /> 3. A file that is actively being worn; r by END may not be Immediately available for revlaw. A new Application may be <br /> submitted when the fila Is AV Ila I <br /> a "_ <br /> 4. Any fl lo not returned In the same Altion as . )used will be reorganized by EHD staff at the expanse of the applicant_ <br /> Future file revlews by the came A cans;may ':` ire a$122 deposit prior to review. <br /> 1 <br /> `. I' '•j , EH�UaEONLY <br /> Gi � •i <br /> I <br /> j,Z <br /> E►lo u-oa <br /> i <br /> e;:. ;'.[ <br />