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Feb, 28. 2005. 9: 0BAIYI No. 1391 P. 17L of <br /> Vn!a ncucrvLui[ LHU LVQ NUM6W <br /> SAN Jo s urN CoUlvTY <br /> ENvO1�zv7rAL DPAtTMENT <br /> 304 East Weber Avenue, 3"1 Floor, Stockton,CA X95202,2705 <br /> f= €� 8 7005 Telephone. (204)468-3420 Fax,(209)4 64-013 8 Web,M".sjgvv,or&,hd <br /> i;~ I . <br /> ENWRONKE-NT HEALTH pUBLIC RECOIWS RELEASE APPLICATION <br /> p� ,c <br /> APPLICANT. aui!NESSIAGENCYI 114114 a V6 <br /> ADDRESS: L#(I , (7-(M 5 i 6 `�b . Ck % <br /> FHONE(1):gL5i--�Sq_ �11Q3_ PHONE(2):_ `�' I--2-5R :51R71 ' -FAiSIMll.e X51- rtfl� ` <br /> TENTATIVE'APPOINTMENT DATE: 71 MA: PM + <br /> (Plea"allow 10 bvslness days from date of rapplioadon submittal-"Tentaflr'e only-must be uonflnned) ; <br /> ❑ CHECK BOX TO E7CPEDrM REQUMT-003.00 FM(CAM OR PRECK ONLY)-REOL!EST PROCESSED IN;1 BUSINESS DAYS � <br /> t^ SIGNATURE OF APPLICANT k DATE __OZ _Z-��O <br /> �r r <br /> UNrr DISTRIBUTION ❑Unft 1 D unit a Mf S nit d ❑ Unit d ❑ Uiiif A ❑ Other(alactronkll sWrnaps) <br /> ;r <br /> FILE ADDRL5ESS iI I EHD USI;ONLY <br /> $trust# Street Nam& City 1h I ; <br /> 1- L...Ca <br /> w 1 <br /> 5. fC i <br /> 3 <br /> T. <br /> 4. <br /> ri '* <br /> 9. <br /> Specific Ante Range of information Requested:Froml� . <br /> ENVIRONiMENTAL HEALTH DEPAR7MEldT 11.Es <br /> HOUSING ADATMNT !� o SgmWASTE FAMMYM�nCLE l <br /> UriDERGROUND TAN1t(t/ST)CLEANUP tI7>:(LOP) � IO WASTE TFRE <br /> # oa CLEANUP"(NON-LOP) b FOOD FAOILRY o DAIRY <br /> DEROROVNDTANK(MoNnORINWREMOVAL) ❑DOG KENNEL Ir �yyg8�e1NA1PJt*fAEATKENYP� ` <br /> DOUS WMTa GGNQRATOf( O MoTgLI�I RANCH i} Q PUMPER T'RWWARDXNEM TOILETS <br /> TIMERM PERMITTED FACILJTY Q P DOSE FrIAOTEt I d Lwp USE APPrOcATn]N 5nW <br /> ❑TATYDOteODY PORCH 13 POl1�R I>' E erealFYl 1� II <br /> 0 MWPiCALWASTEFACILI7Y <br /> Wal.AND SEFnr-P~T Rwo� AB <br /> ARE AvARl�FOR REVIEW- MpnDAY-FRIDAY B CQ'AbI'�:� - RX00--DIR9 HOLIDAYS. i <br /> les f the list ove <br /> hecking the <br /> 4. List up to ten addresses in the space above. Select <br /> UST selected,We(-Sfax to[2g9r=464 38 or malts the address <br /> appropriate bo*s). At least ons file type M <br /> iea#edd above. Address ranges will not be accepted--for additlanal assLstance with fife addresses,contact <br /> the 151-113.Applications recalved after 3:00 pm will be processed the next 6usinese day. <br /> 2 The EHD will notify the Applicant if any EHD files exist, Ail appointment for review will be confirmed <br /> approximately ten(I u0 days after receipt of application. The files r Gill be held for a maximum of live business <br /> days for review. Appointments should be scheduled accordingly. ;I'i <br /> 3. A file that Is actively being worked on by EHO staff may not be imilitedFateiy eYatlable for review. Anew <br /> lication may be submitted when the fila Is available. R j at fhe a nse of the <br /> aPP y EHD staff � <br /> ,4. Any file not returned in the same condltlon as Mleasdd Will be reargarilzed I3y <br /> applicant. Future file reviews by the same applicant may require�(193.00 deposit prior to review. <br /> tl <br /> I <br /> it { <br />'4 1ti2aA'i4 `! <br />