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01 / 05/ 2005 09 : 56 2094x ' 1118 AGE STOCKTON PAGE 01 / 0 <br /> EHU LW NUIVID cR <br /> SAY JOA.QUIN COUNTY <br /> ENVIRONMENTAL AEAI T14 Il)EPFARTnbFNT I <br /> IAN 0 5 2.005 304 E Weber Ave 31 Floor StocktorIF, CA 95205 I <br /> SAN JOAQUN C&WIV-68-3420 Faxt (209) 464,,01VrXW,C0.SandIjoaqujn.ca.us/ehd <br /> Web . ww.00.sanjoagvin.Ga.us/ehd JJJ <br /> _ <br /> PUBLIC Rr, coRDS RELEASE APPLICATION <br /> � <br /> ENVIE ONMENIAL Own, DEP <br /> APPLICANT: &—mdn e ft --•---• BUSINfiSSIAGENCY: . Ad�an�d C'OOEaVlrolitY12nt21, Inc. <br /> ADDRESS: _ 837 Shaw Road , Stockton CFIFFIFFIVA 95215FAIL <br /> PHONE: <br /> 209-467-1006 FACSIMILE: , 209-487-1118 <br /> - , <br /> APPOINTMENT DATE: Time. ''�� .. <br /> TENTATIVE* A ; <br /> Please allow 10 business days from date of application submittal) <br /> I <br /> 1••��I r <br /> L•J CHECK. BOX TO EXPEDITE REQUES 93.00 FEE -• REQUEST ROCESSED IN 3 BUSINESS DAYS <br /> Ai.. <br /> SIGNATURE OF APPLICANT " G1X�N�L DATE <br /> Depadmont use only <br /> End <br /> UNIT <br /> FILE AD tRFSS <br /> �IF ems( y �� ,_ Pref-p—��c �D /�yy��/ � 0 Unit1 <br /> O, a 991 ,Z 3 S �jtl4f�,7z{�UY7 cn 57 <br /> N ❑ <br /> 3 � uf � U <br /> nt2 <br /> 4, Snl <br /> ®VnilUn.itR <br /> 7. 5•, x1 D 5 z adx �a sr cI Unirr <br /> t <br /> D <br /> city ❑ <br /> \ <br /> f <br /> .a. sl,�el 0i1y <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> N UNDERGROI.IND TANK ('UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT 17 SOLID WASTE FACILITY <br /> M OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> NI UNDERGROUND TANK (MONITORING/REMOVAL) O DOG KENNEL ❑ DAIRY <br /> 19 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMFNT PLANT <br /> ID TIERED PERMITTED FACILITY ❑ MOTEVkIOTEL 0 PUMPER TRUCK/YARDICHEM TOILETS <br /> O TATTOO/BODY PIERCING ❑ POOLISPA 0 LAND USE APPLICATION SITES <br /> ❑ M.EnICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY)��� <br /> 1 . List up to ten addresses In the space above. Select the type(S) of files from the list above by checking <br /> the appropriate box(es). At feast Ons dile type MUST be selected. Fax to 12IFFIFF09) 464.0130 or mail to t e <br /> address lztdI tel above, <br /> 24 EHD will notify the applicanq if any EHD flies exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt of application. The files <br /> will ba held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3, A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> apiAlea0on may ba submitted when the file is available. ' <br /> 4. Any file not returned In the same condition as released will be reorganized by FHIJ staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review, <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff, <br /> 6. Applleations ret.eive :l after 3:00 ptn will be proe"ged the next business drn . <br /> CiJ1iJF. ii3111189 ANB7INTM4 4fie� .A <br /> LiA'TL .CG�N dit eI I§ : pWC IE `. A7' INITIIALS <br /> f�E'tY9EfeD ^T�YE3: :: Na3 JTF2p°VlFibIF lFkTE ', w <br /> eao 4a.ox.voe - - <br /> cror<m� <br />