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45/24/2004 14:50 FAX 209 9480621 002/002 <br /> OATS RECEIVED <br /> SAN JOA.Q1UN COUNTY <br /> ENVIRONMENTAL RULTH DEPARTMENT <br /> 304 E Weber Ave 3'd door Stockton, CA 95205 <br /> MAY 2 (2n$68-3420 Fax: (209)464-0138 web:www.co.san-joaquin.mus/ehd <br /> ENVIRONMENT HEALTHpjjBLIC "CORDS RELEASE APPLICATION <br /> j,/r (Alw <br /> APPLICANT: beaz BUSINESWAGENCY• `e, e-A( <br /> ADDRESS• � '"�� ��oG1 � <br /> PHONE: D Y �7 D FACSIMILE el, <br /> 7 <br /> TENTATIVE`APPOINTMENT DATE: � 0 7 Time:, V <br /> n (Please allow 10 busin"s days from date of application submittal) <br /> u CHECK SOX TO EXPEDITE REQUEST--$93.0.0 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT / DATE /0 <br /> Deparbnent Use OniY <br /> AIL <br /> FILE APDRESS UNIT <br /> ® Unit 1 <br /> z saeea <br /> 3. savor city Unit 2 z <br /> 4. Sueee 011 ..q <br /> S. SWeet U <br /> suset <br /> 7. Suess Unit 4 = <br /> B. 3uetl <br /> 9. sae a LUnit 5 <br /> 10. _ L� vYGO <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNOERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 951souo WASTE FACILrIY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINOMMMOVAL) ) DOG KENNEL �L AW in <br /> KEDAIRY Mir <br /> HAZARDOUS WASTE GENERATOR CHICKEN RANCH ❑ PKG TREATMENT PLANT AN <br /> 7lERED PERMITTED FACILITY ❑ MOTELIHOT EL ❑ PUMPER TRUCIVYARDMHEh17O1LETS <br /> O TATTOOMOQY PIERCING ❑ POOLISPA '¢�%LAND USE APPLICATION SITES <br /> Cl MEDICAL WASTE FACILITY 13 OTHER(PLEASE SPECIFII) <br /> 7. List up to ten addresses in the space above. Select the type(s)of fates 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 fire 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 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 /> POINTM i NT DATE .r _�� •, ':;i> <br /> "UAT�CONp1[�MED - 1 `OPHONE . FAX'.: �`�.0 : lA<: .r^ <br /> �. '14& S <br /> FtkV!l=VilED �_ 1(i=S NO <br /> REVIEW DATE'; <br /> ' EI•W 48-02-006 • <br /> 6fBl��] <br />