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\ Dec-10-04 14:3 5 F r om-TT I ITETRA Tr �M INC +9168520307 T-568 P-01/01 F-945 <br /> SAN JOAQUIN BOUNTY <br /> ENVIRONMENTALETH �EPA.RTM NT <br /> 304 E Weber Ave 3`d Floox tock-ton, CA 95205 <br /> (209 468-3 20 Fax: (209) 464-013$ Wena: www.eo.san joaqui .ca-us/ehd <br /> P .3LIC RECO"S RELEASE APPLIC 'TION <br /> u N SIA F-NCY: <br /> ARpk s�}., j NtV KSIhojk �KlTLf 414 PAjAMe&JTDj CA Z <br /> PHONE: --� 1�J FACSIMILE: I -- 6(, r <br /> -) 3r." ;.r, <br /> TENTATIVE` POINTMENT GATE: JE�-(- - 2-3 OY Tim : t <br /> r1 (Please allow 10 pusinss days from date of applica on Suwlnal) <br /> I--1 CHECK II FOEDITE R QUFST-$93-00 FEE-REQUEST PROCESSED IN 3 suSINESS I!DAYS <br /> SIGNATURE=OF AP EICAN DATE <br /> Depzinment use only <br /> FILE ADDRESS UNIT <br /> C cci-e Cr, STD (] Unit 1 <br /> z S. 152, c <br /> (2-b i}+lam E <br /> Unit 2 <br /> 4v,J g strew 212 I%�'l (A OJ-I cs <br /> H 5 Stmt Cq urnt 3 <br /> s 3naet2..3 V cr C( —WA P <br /> VkA liC11,4iiA h4WIc. 07DAnit <br /> \ N F 8 JW VII C R t�/ D l' <br /> v IIUf 9 5�ea1 t C 1 V C h p 5 <br /> ;�'S; ,o stet 3 S_ acas C <br /> 3Q <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)C FANUP SITE(LOP) 0 HOUSING AGATI_MENT O WD WASTE FACILITY . <br /> J' QTHER CEFANUP SIT (NON-L P) E3 FOOD FACILITY [7 I..ID WASTE VEHICLE Ff1 <br /> 6� UNDERGROUND TANII(MONIT RINGIREMOVAL) 0 DOG KENNEL A AIRY <br /> HAZARUOUS WASTE GENERA OR M CHICKEN RANCH ❑ G TREATMENT PLANT <br /> Z!, <br /> TIERED PFRWTTFD FACILITY M MOTEIIHOTEL o MPER TRUCK/YARDICHF-M TOILETS t� <br /> 177 TATT00itiODY PIERCING M POOLI$PA 0 D USE APPLICATION SITES <br /> M MEDICAL.WASTE FA ILITY M OTHER(PLEASE SPECIFY) ► <br /> 1. List up to n addresses in the space above. Select the types)of fila from the list above by checlan(q <br /> the approp 'ate bo (as). At least one file type MUST be selected. Pax o 20,_ 464-0138 or mail o the <br /> ess indicated Bove. <br /> 2. EHD will notify the 0ipplicant if any EHD files exist. An appointment fo:r review will be confirmed <br /> approximately five Puuinews days but no later than ten (10)days after eceipt of application. The files <br /> will be held for a m ximum of five business days for review. Appoin ents should be scheduled <br /> accordingly. <br /> 3. A file that- activel being worked on by F-II staff may not be immed ately available for review. A ne <br /> applicatiorlmay be submitted when the file is available. <br /> a. Any file not return in the same:condition as released will be reorgar ized by EHD staff at the expens <br /> of the ap=plicant. F ture file reviews by the same applicant may requir a$93.00 deposit prior to revie• <br /> S. "TFNTATI int <br /> tment dates must be confirmed with EHD staff. <br /> 6. Appiicatio s rete" ed after 3:00 pm will be process:ud the next busine s day. <br /> CONFIRM>:P APP INTMI:. T DATP TIME <br /> PATE CONFIRIVIF-P PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW BATF <br /> E804"2-ON <br />