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Dec 08 04 02: 37p Hanover Inc 5311-342 1490 p. 2 <br /> EMO LOG NUMBER <br /> care Dv¢?II'a fa ,, ji` AN JOAQUIN COUNTYPUBLIC I4EALTH 5EF�lCES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> DEC 8 2004 304 EAST WEBER AVENUE,THIRD FLOOR <br /> 570CKTON CA 85202 <br /> Pr , rt I 1R (209)468 420 tDS RELEASE APPLICATION <br /> APPLICANT L-� hA a` K1 —BUSINESSIAGENCY +4 OLS-N0V <br /> 6rlmo <br /> ADDRESS <br /> 10?Z I-4afa+.idCr Sl, <br /> PHONE 19 I FACSIMILE ��•�'f J4 <br /> TENTATIVE''APPOINTMENT DATE Iz Ila �O�l TIME <br /> i 3fl <br /> (Please give 7 to 10 usiness days from date of application aubmlttal) <br /> C1 CHECK BOX TO EXPEDR'E REQUEST•$87.00 FEE-REQUEST PROCESSED IN 9 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �r�"��' �� ) DATE <br /> FILE AODRES$ IS SIDE EHO S7AFF USE ONLY <br /> R00 ELEMENTS SEARCH <br /> 014 E, FfGMOnt S+,, St-021-42- 1r'21- <br /> 7-9T-0-h1• An+e-rOS <br /> 2Ic3o � F•re.mon s} <br /> o n's - M�nar A.Lc. V)I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> d UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> d/OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDERGROUND YANK(MONITORINOIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> [+J HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKO TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOTEUHOTEL 0 PUMPER TRUCK/YARDICHEM TOILETS <br /> d TATTOOISODYPEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY '❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. 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 indigated above. <br /> 2. FHD 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 /> wil�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 new <br /> applic4tion may be submitted when the file is available. <br /> 4. Any flit, not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $87.00 deposit prior to review. <br /> 6. 'TENTA -!VE appointment dates must be confirmed with EHD staff. <br /> S. Applicatii'ris received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOIIiITMENT BATE TIME <br /> DATECONFIRMED PHONE. FAX. INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> __ ._. TDTRL P.01_. <br />