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r L'rrj LOG NUM IDCII <br /> 11 SAN JOAQUIN COUNTN' <br /> NO 2 2007 ENVIRONMENTAL HEALTH AEPAR`Z MEN'T <br /> 304 E Weber Ave 3r' Floor Stockton, CA, 95205 <br /> ENVIRONMENT )468-3420 Fax: (209) 464-0138 Web: www'.co.san-joaquin.ca- s h;26fo ma <br /> P'FRJVIT/SERV C <br /> PUBLIC RICCORUS RELEASE APPLICATION / <br /> APPLICANT: �/ C.G BUSINESS/AGENCY: A41 <br /> ADDRESS: ` Q WU_,Sh, ,J OJ0,A;j <br /> PHONE: 3W-1 ^ 3-tv ` FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: 4_�1 ( �'�I0!} Time: 1 ' <br /> r <br /> (PleasD allOw 10 business days from date of application Submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE I 7 D 0 <br /> Department Use Only <br /> { _FILE An RE9S UNIT <br /> 11 street -59%� /I. .f.AJ�`�����}'_-1 cit ❑ Unit 'I <br /> n <br /> 9. Streel 3 9 l3 2' A Rey. `�—"� ell Unit 2 <br /> A. Street 3q 1 u ,�,J� Q , `�r\ ell - a ,� <br /> 5. Street ✓ „r r 'J ell Unit <br /> 6, srccl O Vl/(�S{G�" WT <br /> cuv <br /> 7. Slrcet J27�J 1-t- r a W GI <br /> a, street 7 d /Q��� It <br /> 9. $Irc,l ([^�'' /�rfi L �'a: �Il _ Unit <br /> 10. Slrrrl k�J E <br /> c <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLI . <br /> 71 OTHER CLEANUP SITE(NON-LOP) 11 FOOD FACILITY d SOLID WASTE V CLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) © DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR © CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY CI MOTEUHOTEL ❑ PUMPER TRUCKIYARDIGHEM TOILETS <br /> 0 TATTOOiBoDY PIERCING 1`1 POOUSPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY © OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD 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 /> 3. A file that is actively being worked on by EHD staff may not be immediatQly 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 /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. 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 /> EWD 40-024)06 - <br /> 81tSf200� <br />