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(M`AR-16-2007 09:01 "TOR EARTH TECH 209 532 0773 P.01i01 <br />OAIN J Vt%%ZUii\ 4vvi� a w <br />ENV-fRO MMNrAL MALTH DEPARTI,..-. NT <br />�r� 200 304 E Weber Ave P Floor Stockton, CA 95205 <br />2006 09) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.mus/eh <br />ENVIRONMENT HEAUH <br />PERMIT/SERVICES PU13LIC RECONS RELEASE APPLICATION <br />ON <br />e, Q ones <br />BUSINESSIAGENCY: 4n=�:Q K)1-0 LCA <br />2$Z3� <br />APPLICANT: <br />ADDRESS; c�- foto n, "Bpqto L r - <br />PHONE: • Jr a , 6 FACsimil-E: _ o� q B a - b a 7-3 <br />TENTATIVE' APPOINTMENT DATE: 19 " 00 c�, 20ine: q; r <br />(Please allow 10 business days from date of application aubmlttaq <br />CHECK BOX TO EXPEDITE REQUEST - $93-00 FE - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATUREOF APPLICANT DATE 16 <br />pe0artrnent Use Only <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNIT <br />❑ Unit 1 <br />Unit 2 <br />'A <br />Unit 3 <br />Unit 4 <br />(P, Units <br />>v UNDERGROUND TANK (UST) CLEANUP SITE (LQP) W HOUSING ABATEMENT V SOLID WASTE FAC1 ~ <br />OTHER CLEANUP SITE (NON -LOP) ID FOOD FACILITY Fd SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />kr HAZARDOUS WASTE GENERATOR L7 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />cl TIERED PE-mrrTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br />❑ TATTWI3013Y PIERCING ❑ POOLISPA 0 LAND USE APPLICATION SITES <br />�7 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 209 404-0138 or mail to the <br />address indicates 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 EHA 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 />g, 'TENTATIVE appointment dates must be confirmed with EHD staff. <br />5. Applications received after 3:00 pm will be processed the next business day, <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE PAX INITIALS". <br />REVIEWED YES NO REVIEW DATE <br />TOTAL P.01 <br />