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DATE RECEIVED SAN JOAQUIN COUNTYt~HD LQG Rvvrn=: <br /> ENVIRONMENTAL REA,S.Tu DEPARTMENT <br /> 304 )1 Weber Ave 3� Floor Stockton, CA 94205 <br /> Z356 <br /> (209) 468-3420 Fax: (2,04) 464-01,38 Web: w,�vwv.cc�.s -joaquin.ca.uslelad <br /> PuBuc RECO"S RELEASE APPLICATION <br /> r rC F�S� `2J <br /> APPLICANT; BUSINFSS[AGENCY: ° <br /> � £ .� } � S <br /> ADDRESS 'f (� *� '�' �}} r c� C/ <br /> � <br /> PHONE:�I C) I FACS IMIL_ <br /> TENTATIVE"APPOINTMENT DATE: A3 r` e <br /> (Please allow 10 business days from dete of application subrnIttai) <br /> C14ECK Bax TO EXPEDITE R UE T-sn.00 F —REQUEST PROCESSFI)IN 3 BUSiNE,SS DAYS <br /> SIGNATURE OF hPPLICANT l?ATE <br /> DeR3 n.",Use only <br /> FILE ADDRESS <br /> AV j <br /> a. Vvmeol E] Unit 2 - <br /> 4. 51ree, r G4 <br /> ( ' Unit J <br /> G <br /> fi, S+�eal <br /> GI Unit 4 <br /> 8. $trget Gt <br /> ❑ Unit 5 <br /> G � } <br /> 19. Sime! <br /> ,y. <br /> ENVIRONM TFAEwNT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ OUsING ABATEIA"T ❑ SOLID WASTE FACIL" <br /> CI FACILE T Y ❑ SOLID WASTE.VEHICLE <br /> p FORD <br /> OTHER CLEANUP SITE(NON-LOP) DAIRY <br /> UNDERGROUND TANK(r�ON1TORiNGlRf=N40VAL © DOG FACI) LI.❑ CHICKEN RANCID ❑ PKC TREATMENT PLANT <br /> HAZARDOUS WA5TE GENERATOR p MOTELIHOTEI.. O PUMPER TRUCK/YARDICrHEM TOILETS <br /> TIERED PERMITTED FACILITY p POWSPA ❑ LAND USE APPLICATION SITES <br /> C7 TATTOOlHOCY PIERCING LI OTH5R(PLEASE SPECIFY) <br /> 0 MEDICN-WASTE FACILITY <br /> 1. List up to tett addresses in the space above. Select the types) of files from the list above by cheering <br /> the appropriate box(es). At least one file type MUST lee selected. Fax to 2023 464-013B or mail tO the <br /> address indicated above. <br /> 2• I-ll?will notify the appliCant if any EHD files exist. Ali sppflintment for review will be confirmed <br /> approximately five business days but no later than ten 1;10) clays after receipt of application. Tile files <br /> will be.held for a rriaximUM of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked an 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 EHi] staff at tl!e expense <br /> of the applicant. Future file reviews by the sante applicant may require a$93.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> S. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME - <br /> DATE CONFIRN15D PHONE; FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Erna aa.oz-aos <br /> emr�ona <br />