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re +9168520307 T-017 P.01/02 F-227 <br /> Aug-09-04 21:43 From-TTI TETRA TECH . NC • <br /> EHO LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> InECI�.11�"�1 ED' ENVIRONMENTAL HFALTIi IIF PARTME T <br /> 304 F Weber Ave 3ra Floor Stockton,CA 9520 <br /> AUG 1 0 2004(209 468-3420 Fax: (209)464-0135 Web: WwW.CO.San joaqu' ca.us ehd <br /> ENVinuNIOENT HEALTHEU I IC gECORAS RELEASE APPLICA ION <br /> PE r L �H Ali <br /> APPLICANT. �t=flat �. L.D� BUSINESSIAGENCY. \6 Z <br /> ADDRESS: 1 IRC <br /> �$t NC kF0 Got V C!4 6 775 <br /> PHONE: Q I ti— 15--3- 4 54b FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: '/n' y Time: <br /> (phase allow 10 nasinass days from data of application sul" aq <br /> Q CHECK 130X70 EXPEDITE REQUEST-597-00 FEE-REQUEST PROCE PIN 3 B 'IN E3S O Y9 <br /> SIGNATURE OF APPLICANT DATE /U6 <br /> Deprin,04111 use Only <br /> UNIT <br /> ADDRESS <br /> 2-2z E. `"0 115114 IF. C. 6Tb t G E] unit 1 <br /> 2. sweat S- � &A ALKI e <br /> sea 39. IPLc l7 Una 2 <br /> a sax 3 1' <br /> 5. Saaul J;+. Yd G �Unlf3 <br /> i�tr� 7 C. 6 <br /> i J1 y. Siaat 2 -L' r�I` C Una 4 <br /> "At <br /> 9,e a -T L ✓ p t 5 <br /> ENVIRONMFNTAI-HEALTH DEPARTMENT FILE <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HouslNc A13ATEMENT A SO D WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ 50 D WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL- ❑ DA Y <br /> ❑ GHIGKEN RANCH 0 PK TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR M MOTFUHOTEL ❑ Pu <br /> PER TRUCKIYAROrCHFM TOILETS <br /> Q TIERED PERMITTED FACILITY ❑ POOUSPA EM, D USE APPLICATION SITES <br /> C3TATTOOBODY PIERCING C3 OTHER(PLEASE aPECIFYJ <br /> ❑ MEDICAL WASTE FACILITY <br /> 1. List up to ten addresses in the space above. select the type(s)of files f om the list above by checking <br /> the appropriate box(es)- At least one file type MUST be selected. Fax t 209 464 0138 Or marl to the <br /> address indicated above. appointment for eview will be confirmed <br /> 2. EMP will notify the applicant It any EHO files exist. An <br /> approximately five business days but no later than ten(10)days after r eipt of application. Tne files <br /> will be held fora maximum of five business days for review- Appo)ntm ma should be scheduled <br /> accordingly <br /> 3. A file that is actively being worked on by FHP staff may not be immedia ely available for review. Anew <br /> application may be submitted when the file is available. <br /> 4- Any file not retumed in the same condition as released will be reorgan by EHD staff at the expense <br /> of the applicant. Future file reviews by the some applicant may require $93.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHO staff. <br /> 6. Applications received after 3:00 pm will be processed the next bus)nes day. <br /> LR%F1AFWFT) <br /> RMFD APPOINTMENT DATE TIME <br /> ONFIRMED PHONF FAX INITIALS <br /> YES NO REVIEW DATE ` <br /> erl0.sasoue _ <br /> srxrzom <br />