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10/28/2005 10:03 20952242 GEOLOGICAL TECHNI PAGE 01/01 <br /> EHD LOG NUMBER <br /> DATE RF-CEtVEo SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2005 OCT 28 AM 9:299E weber Ave 3 Tivor Stockton;CA 95205 <br /> uin ca us/ehd <br /> (209)4683420 Fax: (209)464--0138 Web: w�'N �°� <br /> s ; ;u:', c o u ;i T Y RDS RELEASE APPLICATION <br /> rENV1, off- H RECO <br /> �r� v V'Q.U1 Q. <br /> APPLICANT' SUSINESWAGENCY: C 5 <br /> ADDRESS: <br /> q cl <br /> a�� <br /> PHONE: FACSIMILE: o <br /> TENTATIVE`APPOWTMENT DATE:�t� s o�� 1l-l- 5 Tirt►e: v r <br /> MMM aRow t0 busintoa days ttom daft of application st'"'nO <br /> CHECK BOX TO EXPEINTE REQ ST-'$93.00 FEE-•RFQU ST,pKoCESSED 1N 3 81,13INESS DAYS , O Q s <br /> x x <br /> SIGNATURE OF:APPLICANT DATE <br /> DATE �� <br /> oepanmerd Una 01'dy <br /> UNrr <br /> FILE ADDRESS <br /> iz: <br /> p Unit 1b . ez b 5 W • fan.,:'C�- �' ' 1] Unit 2 <br /> 3. six <br /> \0 8 5 c.a. <br /> a. tUnft 3 <br /> � freta <br /> t'�. S• S�� it5 <br /> ia. save+ 7 YY1l�- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES � <br /> >. <br /> M UNDERGROUID TANK(UST)CLEANUP SrTE(LOP) ❑ HOUSM ABATEMENT ❑ SOLIO <br /> WASTE FACT <br /> C1 OTHeR CLEANUP SItE(NON-LAP) ❑ FOOD FACILITY <br /> E3 SOLID WASTE VEHKXE <br /> !a UNDERaM3,UND TANK(MONiTOMNO AL) <br /> El KENNEL ❑ PKGDAIT <br /> 40 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANG" O PUMPE ETRUCKT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER U E AppUYATION SITE TOILETS <br /> ❑ TATTOOi80I?l PIERCING ❑ poot SzPA ❑ LAND USE APPLICATKNi SITE-5 <br /> 0 pRED1CAL WASTE FACILITY ❑ OTHER(PLEASE ypECiFY) <br /> list <br /> hecking <br /> 1. LWt up to ten address"In the space above. be he selected PO(Sf Fox to(fileg from t1464-0'f$ or mall to the <br /> the appropriate box(es). At least one file type MUST <br /> Ms rttment for review will be confirmed <br /> 2 EHD will notify the applicant If any EHp files exist An appoi after receipt of application. The flies <br /> approximately five business days but no later than ten(10)d� ter rec i should be scheduled <br /> wilt be held for a maidmum of five business days for review. Appo <br /> accordingly. <br /> 3. A file that Is actively being worked on by EHD staff clay not be Immediately available for review• Anew <br /> application may be submitted When the file is available. FHD staff at the <br /> 4. Any file not r�t'•trned In the carne condition as released m reorganized <br /> a$93.00 deposit prior to revieW- <br /> of the applicant. Future file reviews by the same app y <br /> g, *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> g, AppRcations received after 3:00 pm will be processed the next business day, <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRAscD PHONE FAX INITIALS — <br /> REVIEWED VES NO REVIEW DATE <br /> s W2M <br /> OCT 31 2009 <br /> OCA 9, <br />