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MAR -16-2007 09:01 C—DOR EARTH TECH <br />aAlvdV^VUul 209 532 0773 P.01i01 <br />ENvmmwNTAL HEALTH DEPARTWNT <br />IV, A P, 6' 200 304 E Weber Arse P Floor Stockton, CA 95205 <br />(�09) 468-3420 Fax: (209) 464-0138 Web: www.co.san joaquin.ca us/ehd <br />ENV!R0N i 11 i EALI-H <br />PERMIT/SERVIHIS PUBLIC RECONS RELEASE APPLICA'T'ION <br />�h�'rEtC6e on2S <br />APPLICANT: PATS C( AGENCY: en ki WR_ (aA EA H <br />ADDRESS' ol-N46 -s B p A N L !V G <br />PHONE: 2-o9 , na_ a G FACSIMILE: ;20 13 -7-'-3 <br />/ U d <br />TENTATIVE' APPOINTMENT DATE: I 1 " � ma c'', me: q; <br />completed <br />M CHECK BOX TO EXPEDITE R1 <br />C <br />SIGNATURE OF APPLICANT <br />Sveet <br />1a. Saeet <br />(please allow 10 business days from date of application submittal) <br />- $93.00 FEE; - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />DATE 16 <br />U DepaLent Use Only <br />N <br />vl�•If- - <br />•F.F. <br />F. <br />ENVIRONMENTAL, HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) W HOUSING ABATEMENT SOLID WASTE FACT <br />OTHER CLEANUP SITE (NON -LOP) L3 FOOD FACILITY F+ SOWD WASTE VEHICLE <br />UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />C] TIERED PERMITTED FACILITY M MOTEUHOTEL M PUMPED TRUCKIYARDICHFM TOILETS <br />❑ TATTOOISODY PIERCING ❑ POOL/SPA 17 LAND USE APPLICATION SITES <br />LZ MEDICAL WASTE FACH-ITY ❑ OTHER (PLEASE SPECIFY) <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list aboye 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 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 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 />CONFIRMED APPOINTMENT PATE TIME <br />DATE CONFIRMED PHON5 FAX INITIALS`. <br />REVIEWED YES NO REVIEW DATE <br />UNIT <br />[] <br />Unit 1 <br />Q <br />Unit 2 <br />Unit 3 <br />Unit 4 <br />Unit 5 <br />TOTAL P.01 <br />