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Avr •27 . 2004 1 05P P' 0. Anderson & Assoc . <br /> No , 4929 t`P • 2J`4UN'"L <br /> DATE Kt- .c'vC SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> -joaquin.ca.us/ehd <br /> (209)468-3420 Fax: (209) 464-0138 Web: v;ww•co.san <br /> APR 2 7 2004 <br /> BLIC TE' COIZ-DS RELEASE APPLICATION <br /> BUSINESSI �Q� � (� • �-,�d,ensn'` -+- Fps sa c . <br /> AGENCY: <br /> APPLICANT:- <br /> ADDRESS: 8 S FACSIMILE: 34R ' `FZZ <br /> PHONE: 3(0- "3 1 <br /> Time: 01 01 � <br /> TENTATIVE"APPOINTMENT DATE: <br /> (Please allow 10 business days from date of application submittal) <br /> ,v <br /> ❑ o <br /> CHECK BOX TO EXPEDITE REQUEST-$93.40 FEE-REQUEST PROCESSED IN 3 BUSINESS DAY <br /> DATE <br /> SIGNATURE OF APPLICANT Department Use Only <br /> UNIT <br /> FILE ADDRESS <br /> city S 6 , ❑ Unit 1 <br /> 1. street 33 <br /> 2-- CityS <br /> 2. Steel 3`17 4 <br /> r ��,�hS Q"1� ' ❑ Unit <br /> 7 L. Yr�AuO <br /> street 30 S. O1'v�. Pc-tr�. Gt C.It � J <br /> 1 ; S-}-a r✓ Unit 3 <br /> Street `444) <br /> e street a lie Unit 4 <br /> 7. street G <br /> 9. street G ❑ Unit 5 <br /> 9. Street G <br /> 10. Street <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> ip UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 0 OTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL ❑ DAIRY <br /> $8 UNDERGROUND TANK(MONITORINGIREMOVAL) E3 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR C3 MOTEL[ RAN ❑ PUMPER TRUCK/YARD/CHEM TOILET <br /> TIERED PERMITTED FACILITY ❑ ppoUSPA ❑ LAND USE APPLICATION SITES _ <br /> ❑ TATTOOIBODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <br /> List up to ten addresses in the space above. Select the type(s) of files from the list above by checkil <br /> 1. e MUST be selected. Fax to 209 464-0138 or mail to th' <br /> the appropriate box(es). At least one file type <br /> address indicated above. ointment for review will be confirmed <br /> 2. EHD will notify the applicant if any EHD files exist. An app Itc onf r The file <br /> approximately five business <br /> of five business days for ays but no later than e review. Appointments n (10) days after shou should scheduled <br /> will be held for a max <br /> accordingly. worked on by EHD staff may not be immediately available for review. A r = <br /> 3. A file that is actively being <br /> application may be submitted when the fife is available. D staff at the expet <br /> 4 Any file not returned in these iews bycondition <br /> the same apptc wilanti be may require a X93.OHdepos t prior to rev <br /> of the applicant. Future Elle r <br /> 5 *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> eceived after 3:00 pm will be processed the next business day. <br /> g Applications r ` <br /> TIME <br /> GONFIRMEU APPOINTMENT DATE INITIALS �— <br /> PHONE FAX <br /> DATE CONFIRMED <br /> REVIEWED <br /> YES NO REVIEW DATE <br /> EHD 48-02-006 <br /> lw 72003 <br />