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•• _ vru� v~• rd <br /> EN-,:-'WNMENTAL <br /> HEALTH DEPARTN NT <br /> 3 Weber Ave 3 Floor Stockton, CA 95 <br /> APR 0 6 ?(�gQ) 468_3420 Fax: (209) 464-0138 Web: www.co.San-}oaquin.ca.us/ehd <br /> ENV€Ru vlVlLiu i- HEALTH PUBLIC RE RELEASE APPLXCAT�ON <br /> PEt 11'JIT/SERVIC <br /> � BUS1N>=5SlAGENCY: ATC ASsoc.i.,T�r <br /> APPLICANT: <br /> ADDRESS.• till LoY►a Pw�». ,�e Sv, eB /`'loe�eTo 14 <br /> PHONE. <br /> �i FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> >7 <br /> (Please allow 10 business days from date of application submittal) � <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED 1N 3 BUSINESS DAYS <br /> DATE 6- <br /> SIGNATURE OF APPLICANT Department Use Onl _ <br /> UNIT <br /> FILE ADDRESS <br /> 1. sheet Y9Ff� brf W= c S k '"' ❑ Unit 1 <br /> 2. Street 9 p 606 S.��'/ DY G S'i-aC.j<4,. N <br /> `t! <br /> s. Street <br /> 4110 'S, �}►iv ay W G 5 o,le Unit 2 <br /> � � <br /> �12 !� No ?dpi <br /> 4. Street 2. . ir or W Ci � fIC o <br /> 5. 2voo St t V020 v .. L.1 G I(: <br /> vee M Unit 3 tvee5'f'. roh Roy. G St <br /> 7. 31-1 _50s G it 4 <br /> e. street �61 I S. 4�� a r.J., ✓� a <br /> 9. stmet <br /> �}S� S. t,vf �►- G 5)e.k�.� 352& E] Unit 5 <br /> Ci <br /> 10, SVeet <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> SOLID WASTE-F tttT�f w� j ., � <br /> ,,UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q HOUSING ABATEMENT p SOLID WASTE V�ICL '` ca ij <br /> OTHER CLEANUP SITE(NON-LOP)' CI FOOD FACILITY <br /> El DOG KENNEL ❑ DAIRY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOGCHIKEN RANCH E3PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR El MOTEUHOTEL C3 PUMPER TRUCKIYARDICHEM TOILETS <br /> 13TIERED PERMITTED FACILITY d POOLISPA ❑ LAND USE APPLICATION SITES <br /> CI TATTOOIBODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <br /> t <br /> List up to ten addresses In the space above. -Select the type(s) of tiles from the list above by checking <br /> 1. p <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 249 464-0138 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 /> eceipt at application. The files <br /> approximately five business days but no later than ten (10) days after r <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 immediately avallabie for review. Anew <br /> application may be submitted when the file is available. <br /> 4. Any file not returned !n 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. 7. <br /> 6. Applications received after 3:00 pm will be'processed the next business dar, <br /> C014 IRME.D APPOINTMENT DATE TIME <br /> IAL <br /> DATE CONFIRMED <br /> PHONE FAX --� <br /> S <br /> REVIEWED. YES NO REVIEW DATE <br /> EHD 48-02-006 - - - <br /> I` <br /> W=003 . <br />