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� . <br /> 'ROM Geo-PI-ase Environmental WC. FAX NO. 2095650295 Qun. 09 206 0323f�i`'i P2- <br /> »- n EHD LOC NUM3GR <br /> GATE RECEWErD SAN JOAQm COUNTY 1J <br /> EN <br /> D VMONMENTa BEALT,1 DEPAiR.T MMN'T <br /> oGD <br /> E C-2� V E 304B Weber Ave 3'F1oar StOcktan,CA 95205 <br /> JUN 9 <br /> X00&.209)468-3420 Fax: (209)464-0138 Web: W <br /> WW0o•san joaquin.ca.. uslehd <br /> ' ENIRONMIN i HEALTH PUBLIC RECO <br /> RI)S RELEASE APPLICATION <br /> V <br /> � p r <br /> 4,- SUSIHESS(AGENC) <br /> APPLICANT: ) �1 F <br /> FACSIMILE: <br /> Time:� <br /> TEtTrAT1VE�ApFojHT i>=NT DATE: ;r <br /> (Floose allow i©business days from data of applEcatloo submittal) <br /> CHECK SOX TCt FXPEAi31= <br /> REQUEST.$53.00 FEE^REQUEST PROCESSED IN 3 E lNESS PAYS <br /> I DATE <br /> SIGNATURE=OF APPLICANT <br /> � rfment Use Only <br /> l� U IT <br /> FILE ADDRESS <br /> # ,. d' !.! /� *� �" <, ❑ Unit 1 <br /> OF 4r <br /> a' fr d1f td Unit 2 <br /> eCOY <br /> orunit 3 <br /> 5, Strest t .' <br /> e. 8traei ! r)It+ <br /> 7. Sveet �p I , <br /> B Street ❑ .�ung 5 <br /> 9, Sven! <br /> �. 10, S4eet i <br /> ENVIRONMENTAL.HEALTH DE TIME?NX FILES <br /> NG ABASEMENT :" M.;OUD WASTE FACILITY <br /> ," <br /> I UNDERGROUND 7O HOUSI <br /> ANK(UST)CLEMUP SrM(LOP) Q FOOD HGG1L1 fY 0 SOLID WASTE VEHICLE <br /> 'OSHFK CLE{WUF SITE✓(NOWLOP) ;U DOG 1{l=NNEI: Ea!',DAIRY <br /> UNOERGROUND TANK{MONITORINGIREIrIOVAL} Cl CHICKEN RANCH' p I PKC TREATMI HT PLANT <br /> d HAZARDOUSWASTE GENERATOR '� d PUMpF-tTRUCKI'lARDICHEM TO <br /> iLEYS <br /> o TIERED PERNIn-FED FACILITY Ct NIOTELfIIOTEL M LAND USE APPLICATION sITE=S <br /> 0 TATTOOIBODyPIERCING 0 pOOLISPA FY)'i <br /> 0 MEDICAL WASTES FAGiL17Y 0 OTHER(PLEASE SPEC] <br /> 0 list <br /> 1_ List up to ten addresses in the space above- M ST be ape sad f fil stool 464-013$abovor myai h o thug <br /> + the appropriate boxi es). At least one type <br /> address indicated above. be confirmed <br /> 21 F-HD Wall notify the applic"t If any EHE)flies exist. An appointment of review w <br /> t f ai plication. he files 1 <br /> approximately five 1,usiness days but no Later than tern('f 0)slays ol[ytments should e scheduled <br /> will be held for a maximum of flue business days for revievw,-' P <br /> accordingly' EHD staff may net be immdittely avaliable for review. Anew <br /> 3. Afile that Is actively being worked art by Y <br /> appllaation may be submitted when the file is available. 4 <br /> q.. Any file not retu mad in the same condition as <br /> released will <br /> may r �$93 ed by Odd P prior to rev erg. <br /> of the applicant. Future file reviews by the same ape' Y <br /> 6_ +TENTATIVE appoiratrnent dates must be confirmed with EHD staff.r <br /> {' 6 Applications received after 3:00 peri will be processed the next business day. <br /> E <br /> CONFER-MED APpOINVENT,DATE v4M� <br /> + :RR�NI: L=AX.. iN47iLs> - <br /> 1 <br /> DATE CON FiR11F E D " <br /> REVIEWED YES NO <br /> RI~Vii:VII QAC <br /> ownett.az-0os —� . <br /> xrereaoa <br /> f <br />