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5ep-11-03 113::4�73I From-TTI TET' 'CH EM INC +9168520307 T-507 P.02/03 F-803 A <br /> C� �� I l �"I I_��� SAN QUIN COUNTYPUBI fC HEAI~TH ERVIe�s 4LUVryvµu~ <br /> n1 _>.� �, <br /> ENVIRONMENTAL. HI-AL.TH DIVISION <br /> SEP 1 1 2003 304 EAST WE13ER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> ENVIRONMENT HEALTH (209)468-3420 <br /> ER�4IT/SERVICES PUBLIC RjrOORIDS RELEASE APPLICATION <br /> sa h SI l��NGY h l�-(�.�-oki E:'114e <br /> APPLICANT / 13USINSSAI= <br /> ADDRESS GJ/;4� Q /DO Rovrtc.h o (2ord0c_,0L_ C%ff- 9s <br /> PHONE 4' 3�i SJ�lo FACSIMILE I D - Q�30 <br /> TENTATIVE"APPOINTMENT DATE TIME ftr- <br /> (PiCasc give 7 Z01 pus;ncss pays sato of appl,"Gon auorruttal) <br /> xCHECK BOX TO EXPEDITE fRECIUE 567.04 Fid-RE ST PROCESSED IN 3 auslNEss RAYS W ilk <br /> SIGNATURE= OF APPL-ICANT _ 0-6 DATE <br /> FLI 1=ARQftESS THIS SIDE F-HO STAFF(ISE ONLY <br /> PROGRAM ELEMENTSSEArRCtj <br /> O,7 <br /> c <br /> i <br /> ENVIRONMENTAL HEALTH DIVISION FILES �j <br /> ON99RUROUND TANK(UST)CLEANUP SITE(LOP) 0 MOUSING ABATEMF-NT TJX SOWP WASTE FACILITY <br /> OTHER CLEANUP SITE(NAN.LOP) O FOOD FACILITY SOLID WASTE VEHICI-E <br /> UNOERGROWND TANK(MONITORINGIREMOVAL) sa Doc KENNEL O DAIRY <br /> HAZARDOUS WASTE GENE TOR ❑ CHICKEN RANCH O'Pxc TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILJTh' o MOTEuHOTEL a PUMPER TRur-KI rARDICHEM TOILET: <br /> CI TATTOO/ROPY PEACiNG C] FCOLISPA '- ' O i.ANR tISE APPLFcATioN SITES <br /> ❑ MEDICAL.WASTE FACILITY ❑ PUBLIC WATER SYSTEM 17 OTHER(PLEASE SPECIFY ABOVE) <br /> I List up to ten addresses in the Space above. Select the type(s)of files from the list.above by checkil <br /> the appropriate dox(es). At least one file Type MUST be selected. Fax to (2091 4s4-013$or mail to In( _rt� <br /> Poress indicated above. n <br /> T <br /> 2. EMP will notify ttpe applicant if any EMD files exist- An appointment for review Will be confirmed <br /> approximately five IqusinesS days but no later than ten (10) days after receipt of application.-The file <br /> will be held for almaximum of five business days for review_ Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively Aging workecs on by END staff may not be immediately available for review. A n <br /> application may pe submitted when Me file is avaiia410. <br /> 4. Any file not rctur�neo in tho same conclWon as releasea will 4e reorganized lay e~Mp staff at the expen <br /> of the applicant. Future file reviews by the Same applicant may require a $137.Oo deposit prior to revi, <br /> 5. 'TENTATIVE: appointment dates must be confirmed with EHD staff. <br /> 6. Applications rece'lved after 3:00 pm will be processed the next business day. <br /> 41, <br /> CONFIRMS Q APPOINTMENT I3AT <br /> TIME <br /> DATE:CONFIRMED PHONE FAX INITIALS <br />