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10/a41t002 11:12 .09-579-2225 C MODESTO AT <br /> PAGE ©1 <br /> SAN JOA UJIV C <br /> Aft OUNTYPU13LIC HEALTH SERVICES rrrr•rr "r""• <br /> 0ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> arm <br /> STOCKTON GA 9320,2 <br /> PUBLIC RECORDS <br /> 468-3420 Aw <br /> RDS RELEASE APPLICATION <br /> APPLICANT Jt Vy � ye e: - 8uslNEssencENCY C, <br /> R �777ADDRESS - Vi . <br /> PHONE Oq lie made -ki <br /> - z,2z r fi <br /> FACSIMILE 1 2 ) 5-7-22R5 <br /> TENTATIVE-APPOINTMENT DATL" 10— <br /> (Plea <br /> so gl a 710 I isusP (�U2- TIME /O 4" PERMIT/SERVICE TH <br /> ® y5 Ir da10 0 PI)II"lion aubrnittal) S <br /> CHECK BOX TO,CXPEDITE REQUEST- <br /> 0 FEE-REQ STP t�SE N 3 13USINESS DAYS <br /> SIGNATURE OF gPPLICANT <br /> DATE <br /> FILE ADDRESS <br /> THIS slot-EHD STAFF USE ONLY <br /> Q' '"d' Crecy- /rj S ! 1RdS• �s PROGRAM ELEMENTS SEARCH <br /> 't S.le Sc 353Tcp� v ck y <br /> �_ 1 +. :z35cv as <br /> I.a <br /> `9 3 350 Trrc a -�+ �! V <br /> Sr lq/r TY fCw+ ��'� Liy S. /lea <br /> yr ✓.S•. 7r� <br /> ENV <br /> UNDERGROUND TANK(LIST)CLEANUP SITE RD N ENTAL HEALTH DIVISION FILES <br /> OTHER CLEANUP SITE(NON-LOP) ( j HOUSING ABATEMENT <br /> UNDERGROUND TANK(MONIITORINGfRGMOVAL C3 FOOD FACILITY d SOLID WASTE FACILITY <br /> C3 HAZARDOUS WASTE GENERATOR j DOG KENNEL ® SOLID WASTE VEHICLE <br /> TIERED PERMI7T D FACILITY O CHICKEN RANCH 0 DAIRY <br /> . <br /> C3 TATTOO/BODY PI11RCING 0 MOTEL/HbTEL ® PUMO PUMPER RUEKG R ATMENT PLANT <br /> MEDICAL WAST11 FACILITY E3 POOL/SPA CWYARD/CHEM TOILETS' <br /> O <br /> O PUDLIC WATER SYSTEM ® LAND USE APPLICATION SITES <br /> 1• List up to ten addresses in the space above. Select the type(s) of files froOTHER(PLCASE SPECIFY AaovE) <br /> the appropriate box(es). m the list above by checking <br /> At(cast one Bite type MUST be selected. Fax 209) 4G4-0138 or mail to thn_ <br /> address indicated bove, <br /> 2• 'EHD will notify the applicant if any EHD files exist. An appointment for review w' <br /> approximately five business days but no later than ten (10)days after receipt of application. <br /> will be hold for a maximum of five business days for roview. q ®in will be confirmed <br /> accordingly, p n. Tho tiles <br /> 1• Appointments should be scheduled <br /> A file <br /> that's actively being worked on by EHD staff may not be Immediately available for <br /> application may be submitted when the file is available. <br /> • Any file not returned in the same condition as released will be rcorganizod by EI-{p staff at oview. q new <br /> of the applicant. Futi re file reviews b <br /> • "TENTATIVE a y the same applicant may require a$87.00 deposit prior to review. <br /> appointment datos must be confirmed with EHD staff. <br /> Applications received after 3:00 pm will be processed the next business day, <br /> ®NFIRMED APPOINTMENT DATE <br /> ATE CONFIRMED TIME <br /> EVIEWED PHONE FAX INITIALS <br /> 00 �e ,� YES NO REVIEW DATE <br /> e <br />