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tta• <br /> p. l <br /> Mar 18 05 10: 45a Hydr,,.ocusI Inc. <br /> 530-756-2687 <br /> EHD LOG NUMBER <br /> 1� <br /> g \`/ EDD SAN JOAQUIN COUNTY <br /> l NTAL HEALTH DEPARTMENT 6(053 <br /> ENVIRONI�IE. 3rd Floor,Stockton,CA 95202-2708 <br /> 304 East Weber Avenue, 4 f,4_O138 Web:Www.S,jgov.org/ehd <br /> 14AR 1 S 7005 468-3420Fax:(209) <br /> Telephone:(209) <br /> ENVIRONhRENT HEALTHS RELEASE APPLICATION <br /> PERMIT/SERVICES PUBLIC RECORD BUSINESSIAGCNCY: rO c <br /> �- / `� �� 95E�� <br /> APPLICANT: �V• / ,7 5 6 2: ��p 735 6 2-6 E <br /> �07� <br /> FACSIMILE: <br /> ADDRESS: PHONE(2): JT} GSC aPHONE(1): i55 L 2 xIYO 2 L'7 Time: <br /> Ei# G1 y must be confirmed) <br /> s from date of applic ion submittal-`TentatWe only- <br /> TENTATIVE"APPOINTMENT DATE: <br /> (Please allow 10 business day 2 O <br /> XPED►TE RECIUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PR DA EED 1N133 8 51 ESS DA <br /> ❑ CHECK BOX TOE <br /> SIGNATURE OF APPLICANT unit 3 unit a <br /> ❑ <br /> Unit; Unit 6 D Other(eledronicilisW�PS) <br /> ❑Unit 1 O Unit 2 <br /> UNIT DISTRIBUTION EHD USE ONL <br /> FILE ARES - cc y- <br /> e <br /> Street# —Stret Nam <br /> 2. -- <br /> 3. <br /> 6. ----- -'—`--- _._ --- - _---- `_ - <br /> 7. - <br /> _9. to <br /> Requested'From <br /> fac Date Range of lntormation Req ' LTH DEPARTMENT FILES <br /> gPecl <br /> ENVIRONMENTAL HEA ❑SOLID WASTE FACILITYNE}IICLE <br /> (LOP) ❑tiOUSINO ABATEMENT CI WASTE TIRE <br /> CLEANUP SITE( b FOOD FACILITY ❑DAIRY TREATMENT PLANT <br /> .c�/„NDERGROUND TANK(UST) 0 DOG KENNEL 0 WASTEWATER RDlCHEM TOILETS <br /> l❑'`+OTHER CLEANUP SITE(NON-LOP} pVAL) ❑CHICKEN RANCH PUMPER TRUCKIY <br /> YJJNDERGROUNO TANK(M GENERATOR <br /> NGlREM E3 MOTELIHOTEL 0 LAND USE AppLICATION SITES <br /> ❑HAZARDOUS WASTE GENERA70R <br /> FACILITY D POOL/SPA SPEC) EXCLUoiNO HOLIDAYS. <br /> ❑TIERED PERMITTEDCl OTHER(PLEASE <br /> Q TATToo1BO0Y PIEROINO MONDAY-FRIDAY 8:00 AM-&-.00M checking the <br /> p MEDICAL WASTE FACILITY 4138 Ot mail to the address <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- S)of files from the list above Y contact <br /> e above. Select the type( 20g file addresses, <br /> addresses in the spat MUST be selected' <br /> Fax LO <br /> 1. List up to ten ted-for Fax assistance with <br /> appropriate box(es)- At least one file type <br /> Address ranges will not be accep sed the next business day• confirmed <br /> ind'lcated above' r 3:pp pm will be prod will be <br /> Ilcations received afte EHD files exist An appointment for review maxi <br /> of five business <br /> the EHD.APP the applicant if any <br /> s after receipt of application The files will be held fora m <br /> 2. The EHD Will notify 10 day available for review. A new <br /> approximately ten( )hays afs should be scheduled accordingly <br /> EHD staff may not be immediately <br /> days for review. Appointments <br /> on by at the expense of the <br /> 3. A file that is actively being reorganized by EHD staff <br /> a be submitted when the file is available.will be it pr'ror to review. <br /> application may require a$93.00 dept <br /> 4. Any <br /> file not returned in the same the satirrole applecant may <br /> applicant. Future file reviews Y --i- <br /> EHD 4442.006 <br /> 1ri"s <br /> i4 <br />