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"fiurcvva 11:1)v V&A Zva 846Ub Z1 10002/002 <br /> DATE RECEIVED SAN JC AQtIN COUNTY cn� <br /> ��..�...,.,,.... <br /> ENVIRONMENTAL$EA.LTHDEPARVYit t'T <br /> RCC DYED 304 E Weber Ave 3'u Floor Stockton, CA 95205 <br /> JUL L <br /> N68-3420 Fai: (209) 464-01',8 W':b:rnvw-co.san joagoin.ca_&ehc1 79Z <br /> (2 <br /> Pp�� T HEALTIPUBLTC RECOM5 RELEASE.APPLICATION <br /> APPLICAN7:M9 ro5;✓7 BUS`INESSlA3ENCY:_ frlu�Ajer_ <br /> ADDRESS: RFeRT 0b� �r� d1P. ;heel ')o/f (A 9)-2O�L— <br /> PHONE: . FACSIMILE: _-&-a3) QLtT— c6al <br /> TENTATIVE'APPOINTMENT DATE: 7i Wo rime: 106Va <br /> (Please allow to basinei days tram date of application submltWq <br /> CHECK BOX TO EXPEDITE REQUEST•$93.00 FEE—REC UEST I+ROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ��✓ DATE / - <br /> \ Oedannlent Use ONy <br /> \V FILE ADDRESS UNIT <br /> HLjf Us T- <br /> 1. s� R /—yJi !Alta- a IC941 Unit <br /> a. s.ee a Dal 5. if B? .j <br /> SeA <br /> a. s�.+ ao _. �URR2 <br /> /�/ <br /> s. s a or g Unit 3 <br /> r. s`e" ae• Unita <br /> e. [] Unit 5 <br /> 1a. sezd cY. <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT AL SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ F(OD FP CILny 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONiTOR1NGIREMOVAL) ❑ DOC KEIINEL In-DAIRY , <br /> m HAZARDOUS WASTE GENERATOR 0 Ct IICKEt'RANCH isL PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILMY ❑ MOTELIT,OTEL ❑ PUMP£R TRUCKlYARDICHEM TOILETS <br /> ❑ TATY001900Y PIERCING 0 Pt 0LISFA to LAND US£APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 O"HER(°LEASE SPECIFY) <br /> 1. List up to ten addresses In the space above. the type(S)of files from the list aboye by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 454-0136 a.mail to the <br /> address indicated above. <br /> 2. EHO will notify the applicant if any EHO'iles exist An appointment for review will be confirmed <br /> approximately five business days but nc later than ten (10) days after receipt of application. The files <br /> will be held for a maximum of five busin:ss d tys for review, Appointments should be scheduled <br /> accordingly. <br /> 3. --Afile-thatis-actively being worked on b1 Eli6staff may not be-immediatelyavailable for-review.. A new- <br /> application may he submitted when the •Ile is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of theiapplicanL Future file reviews by 1 he same applicant may require a $93.00 deposit prior to review <br /> 5. 'TENTATIVE appointment dates must bI: confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be pracessed the nextbusiness day. <br /> GONFtRM D'41??OINTINENTbAT '. t:: % — TIME <br /> DATE CONFIRIVIEO PHONE . FAX'' INITIALS " = <br /> REVi,ENED YES NO REVIEW DATE: <br />