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01/28/2002 13:29 209467AQUIN <br />DAYS RECEIVED <br />COU <br />ENVIRONME <br />304 EAST WEBi <br />,. STOi <br />�2 Jai PUBLIC RECORD <br />APPLICANT l B�\U� � e-' BUSIN <br />ADDRESS ,/I <br />ENTATIVE' APPOINTMENT DATE <br />(Please give 7 to 10 busil <br />CHECK BOX TO EXPEDITE REQUEST - $7m0 PEE -IRE <br />SIGNATURE OF APPLICANT <br />AGE STOCKTL,Iv <br />1(PUBLIC HEALTH Sff,,VICES <br />AL HEALTH DIVISION <br />AVENUE, THIRD <br />TON CA 95202 <br />9) 468-3420 <br />RELEASE APPLICATION <br />EHD LOG NUM13ER <br />P`­J.r <br />IL �L/� <br />TIME — ; <br />daysfromdate of application submittal) <br />EST PROCESSED IN 3 BUSINESS DAYS <br />DATE 2 a OZ <br />AD <br />ENVIRONMENT <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />0 HO <br />OTHER CLEANUP SITE (NON -LOP) <br />© FOi <br />UNDERGROUND TANK (MONITORINGIREMOVAL) <br />O DH <br />WASTE; GENERATOR <br />HAZARDOUS <br />TIERED PERMITTED FACIUTY <br />❑ MC <br />Q TATTOOIBODY PEIRCING <br />© PO <br />❑ P <br />❑ MEDICAL WASTE FACILITY <br />accordingly. <br />A file that is .actively being worked on by I <br />1. <br />List up to ten addresses int <br />:hone <br />the appropriate box(es), Ale filbe <br />address indicated above. <br />2. <br />END will notify the applicant if any EHD f 1 <br />approximately five business days but no <br />will be held for a maximum of five busine7 <br />3. <br />accordingly. <br />A file that is .actively being worked on by I <br />application may be submitted when the fil <br />4. <br />Any file not returned In the same conditio <br />of the applicant. Future file reviews by th <br />5. <br />'TENTATIVE appointment dates must be .I <br />6. <br />Applications received after 3:00 pm will b <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />35 <br />;•rl ML <br />"I SS <br />-* 15.5 <br />(od 1 ix> <br />L HEALTH DIVISION FILES <br />TING ABATEMENT ❑ SOLID WASTE- FACILITY <br />) FACILITY ❑ SOLID WASTE VEHICLE <br />KENNEL. 0 DAIRY <br />:KEN RANCH 0 PKG TREATMENT PLANT <br />ELIHOTEL 0 PUMPER TRUCKIYARDICHEMTOILETS <br />L ISPA ❑ LAND USE APPLICATION SITES <br />LIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) <br />,e. Select the type(s) of files from the list above by checking <br />ype MUST be selected. Fax to (209) 464-0138 or mail to the <br />es exist. An appointment for review will be confirmed <br />ater than ten (10) days after receipt of application. The files <br />;s days for review. Appointments should be scheduled <br />=HD staff may not be immediately available for review. A new <br />is available. <br />as released will be reorgaed by OU��� it prior t the expense <br />same applicant mayrequire <br />onfirmed with EHD staff. <br />processed the next business day. <br />TIME <br />PHONE FAX <br />REVIEWED YES NO I REVIEW DATE <br />INITIALS <br />