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�DA i c RECI_IVEI) <br /> 0 SAN JOAQUIN COUNT 0 L.ttu tit;NUM <br /> r'j�1��i� EN IRON1V EN'.CA.1L. HEALTH.DEPA.R.TMENT <br /> 304 E Weber Ave 3'-d Floor Stockton, CA 95205 <br /> NOV 1 4 2003 (209) 458-3420 Fax-, (209) 464-0138 Web; wwwxuan-joaquilua.us ehd <br /> (1'ViR;;hdNIEIV i HEALTH PUBLIC 1ECOYWS RELEASE APPLICATION <br /> -� 110 <br /> N <br /> APPLICANT."Yo vm 13USINESSIAGENCY: <br /> ADDRESS: . d{ _ <br /> 4- <br /> PHONE: A-f <br /> F CSIMILE: <br /> TENTATIVE*APPOINTMENT E DATE: <br /> Time: <br /> (Please allow 10 buslness days from date of application submittal) <br /> El CHECK BOX TO EXPEDITE REQUEST".$93.00 FEE—REQUES PROCESSED IN 3 BUSINESS DAYS l 2003 <br /> SIGNATURE OF APPLICANT LATE <br /> r/j Department Use Only <br /> " FILE ADDRESS UNIT <br /> 1. SVeel w , <br /> �. street Ci i ✓ Unit 1 !t <br /> 3. Street L Gi r <br /> 4. Street Gt <br /> a t 1 <br /> 6, Buttal Gt Unil <br /> 7. 31reel ` <br /> Ct <br /> ti s. scoot 5 �r le �� l <br /> �Unil4 <br /> ✓� G1 rL 4%/ <br /> ,o. Street -� n c, _ �.) Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) FS HOUSING ABATEMENT O SOLID WASTE FACILITY ' - — 1 <br /> � <br /> THER CLEANUP SITE(NON-LOP) W"FOOD FACILITY E3 SOLID WASTE VEHICLE <br /> ERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> rALARDOUS WAs,rF GENERATOR C3CHICKEN RANCH CI PKq TREATMENT PLANT <br /> I <br /> TIERED PERMITTED FACILITY d MOTEUHQTEL ❑ MPER TRUCKIYARD/CHEM TOILETS <br /> C] TATTOOIBODY PIERCING O POOUSPA LAND USE APPLICATION SITES <br /> ❑ 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 filo type MUST be selected. Fax to t2091 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 immediately 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 IEHD 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 1N171171AL.S <br /> REVIEWED YES NO REVIEW DATE <br /> SND 48-02.40a <br /> 81V2003 <br />