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- --- =�' SAN JOAQUIN COUNTY r EHD LOG NUMBER <br /> I� f <br /> ONMENTALHEALTHDE' P,A, ENT <br /> Weber4 E Ave 3 Floor Stockton, CA 95205 <br /> (209) 468-3420 r'ax: (209)464-0138 Web! www.co.sar�j0agUin.ca.us/ehd <br /> MAR - 9 2006 <br /> Z547 <br /> PUBLIC RECURS RELEASE APPLICATION <br /> R � ^' BUSINESSIAGENCY. NO; � — <br /> 1 <br /> AAf7DFtESs: vet -v�`a -4-1 .tpr, AS S b c <br /> S . <br /> Q 0 � <br /> PHONE. FACSIMILE:, <br /> TENTATIVE"APPOINTMENT DATE: 3 j I (p Time: <br /> (Please allow 10 business days froth date of application subrroltt)DATE <br /> CHECK BOX TO EXPEDITI-REQUEST-$9.3-00 FEE- EQUEST PROCESSED IN 3 t3USINESS D <br /> SIGNATURE OF APPLICANT 3 <br /> Department Use Only <br /> >"ILE ADDRESS UNIT. <br /> t. a rec, My. <br /> z. s, � �? ❑ unit 1' <br /> p at <br /> cfty <br /> ry <br /> Oi a u�o"7� 0 Unit 2 <br /> 5, Street . l 1 tit v <br /> a. siroet :,Unit 3^_ <br /> r. <br /> e, suet Unrt 4 . <br /> City <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(Lop) © HOUSING ABATEMENT Cl i SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑1 SOLID WASTE VEHICLE <br /> Dr UNDERGROUND TANK(MONITORINGIREMOVAL) CI DOG KENNEL U'DAIRY <br /> Vr HAZARDOUS WASTE GEN!~RATOR. 4 CHICKEN RANCH CII PKG TREATMENT PLANT <br /> ?I TIERED PERMITTtD FACILt7Y 0 MOTEIJHOTEL O(PUMPER TRUCMARommem TOILETS <br /> ❑ TATTOOIDODY'PIERCING ❑ POOLrSPA M HAND USI;APPLICATION SrfES <br /> © MEDICAL WASTE FACILITY '13 OTHER(PLEASE SPECIFY} <br /> 1• hist up to ten addresses in the space above. Select the type(s)of files from the fist above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to L2091464-M38 or mail to the <br /> addra;s indicated above. <br /> z• EHD will notify the:applicant if any[AHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10) days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 1 A file that is actively being worked on by EHD staff may not be irnrnediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4• Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> S. Applications received after 3:00 pm will be processed the'next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Erie f6 2-006 <br /> �6lZ60= <br />