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01/28/2002 13:29 20446711 <br />/� bAYE RECEIVED %,/ JO QUIN CO <br />�hCViZ lri�r,���,��,'f / 1 304 EASENVIROT <br />�t12 JQ��20 eN`2 51 PUBLIC RECOF <br />n <br />APPLICANT W - <br />ADDRESS <br />K ;r w <br />�ENTATIVE' APPOINTMENT OATS <br />(Please give T to 10 basil <br />CHECK BOX TO EXPEDITE REQUEST - $7MO FEE - RI <br />SIGNATURE OF APPLICANT <br />AGE STOCKTbN r',.U- `'`/ C` <br />EHD LOG NUMa FA <br />-(PUBLIC HEALTH SE ICES <br />AL HEALTH DIVISION <br />:AVENUE, THIRD Imir. <br />TON CA 95202 A <br />3) 468-3420 <br />RELEASE APPLICATION_ <br />7. <br />(� TIME <br />s��djays3rom dale of application submittal)) WToo <br />)EST PROCEED IN 3 BUSINESS DAYS <br />DATE A Z <br />ENVIRONMENT <br />L HEALTH DIVISION FILES JAN 31 2002 <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />D HO SING ABATEMENT <br />❑ SOLID WASTE FACILITY <br />E3 SOLID WASTE VEHICLE <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ FO <br />D FACILITY <br />❑ DAIRY <br />UNDERGROUND TANK (MONITORINGIREMOVAL) <br />❑ DO <br />KENNEL <br />ElPKG TREATMENT PLANT <br />HAZARDOUS WASTE GENERATOR <br />O CHI <br />KEN RANCH <br />C] PUMPER TRUCK/YARDICHEM TOILETS <br />TIERED PERMITTED FACILITY <br />❑ MO ELIHOTEL <br />❑ LAND USE APPLICATION SITES <br />❑ TATTOO15ODY PEIRCING <br />❑ PO <br />❑ PU <br />LISPA <br />UC WATER SYSTEM <br />❑ OTHER (PLEASE SPECIFY ABOVE) <br />❑ MEDICAL WASTE FACILITY <br />Applications received after 3:00 pm will t <br />1. <br />List up to ten addresses in the space abo <br />the appropriate box(es). At least one file <br />address indicated above. <br />2. <br />EHD will notify the applicant if any EHD f'. <br />approximately fivo business days but no <br />will be held for a maximum of five busine <br />accordingly. <br />3. <br />A file that is.actively being worked on by <br />application may be submitted when the f <br />4. <br />Any file not returned In the same conditil <br />of the applicant. Future file reviews by U <br />5. <br />'TENTATIVE appointment dates must be <br />6. <br />Applications received after 3:00 pm will t <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />Select the type($) of files from the list above by checking <br />I MUST be selected. Fax to (209) 464-0138 or mail to the <br />s exist. An appointment for review will be confirmed <br />er than ten (10) days after receipt of application. The files <br />days for review. Appointments should be scheduled <br />iD staff may not he immediately available for review. A new <br />is available. <br />as released will be reorganized by EHD staff at the expense <br />same applicant may require a $78.00 deposit prior to review. <br />mfirmed with EHD staff. <br />processed the next business day. <br />TIME <br />PHONE FAX INITIALS <br />REVIEWED YES NO I REVIEW DATE <br />