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Mar , 10, 2003 4 :49PM COP EARTH TECHNOLOGIES N1) 2 039 P . I/1 <br /> DAT9 I EUiD LOG NLINUIVR <br /> L . <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL. HEALTH OMSION <br /> MAR 110 2003 304 EAST WE13ER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> !ii j 4MENT HEALTH (209}488-3420 <br /> PERMIT/SERVICES PUBLIC RECQROS RELEASE APPLICATION <br /> APPLICANT'^___: �Q.�. e_ U31N�5 lAGE3JCY 6— els <br /> {�� _ ^! <br /> ADDRESS �► � 1 _- �� �_- <br /> 1 �ft �4 FACSIMILEj� <br /> PHONE --•-- r�^---- <br /> TENTATIVE*APPOINTMENT DATE 0_�- TIME <br /> (Plea.sa give T to to business days from date of aPP11 dtiW subfM"I) <br /> JA <br /> CHECK BOX 70 F_?C}'FALT'E IttaQUES7-U7.00 FEE-RE4UES7 PRO CESS�1N 3 BUSINESS DAY U- n ,.3 , q <br /> SIGNATURE CrAPPLICANT DA �10 <br /> FILE ADDRESS THIS SWE EHD STAJm,F ui UNLY �••�_._ <br /> PfWGP-a A CLEMEPM SACH <br /> 15 d, t7:+ <br /> oo 1, -- <br /> d0 --44 <br /> -- <br /> �r <br /> 1 -7 00 - - <br /> T 1,v1 v I�r,r � ~ <br /> --- <br /> -�-- <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) r] HOUSING ABATErAENT � souD WASTE FACILITY <br /> ©THER CLEANUP SCFE(NON-LOP) Q FOOD FACIL.TTY sOLIC WASTE VIIICLE <br /> UNDERGROUND TANK(MONCTORINGIREMOYAL) ❑ DOG KENNE-L. Q DIURY <br /> HAZME)OUS WASTE GENERATOR to'CHICIO=N RANCH Ci PKG TREATMIENTPLANT <br /> TZ�i DPERfACrTEDFAGILITY 0 MOTELIKOTEI- ❑ PUPAPf�RTRUCKJ)ARI)ICHEMTUll1"i'iS <br /> D TATTOOIBo15Y PEIRCING M PdOLJ5PA d OTHE tL_AVD (PLF- F'L1C:ATi(]N 51 TES <br /> ❑ MEDICAL WA5TE FACILITY 0 PUBLIC WATER SYS7 11A C3 07 II=It{PL C::iP C1FY A�OYI=� <br /> 9. List up to ten addresses in the space above. Select the type(s) of files frarn the 5:5 t above by Checking <br /> the appropriate boxes). At least one file type MUST be selected_ FaX. to-C2-09-L4-0,61-91M or Mail to <br /> address indicato.d.above. <br /> 2. EHD will notify the applicant U any EHD files exist. An appointment for review will be confirmed <br /> approximately five business shays but no Iater than ten (1 U) days after receipt of ai)pllcation. The Arts <br /> will be held for a maximum of five business days for review_ Appointrrlent..shauld be scheduled <br /> accordingly. <br /> 3, A file that is actively being worked on by EHD staff may not be Immedlately availah,lo for review. A new <br /> application may be submitted when tjhe file Is available_ <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expelise <br /> of the applicant. Future file reviews by the same applicant may require a $8T.04 d.lrpnsit prior to review. <br /> S, -TENTATIVE appointment dates must be-confirmed with EHD staff. <br /> 6. Applications received after 3.'04 prn will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME ^T ---_�---� --• <br />