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C�j002 v <br /> —� Cf7V LVV 1\VIv/V Ll♦ <br /> 10/28/2004 13:24 FAX 208 9480E <br /> RECEIVED SANJOAQT.TTN COUNTY <br /> DA ' <br /> ENVIR,ONMENTA.L HEALTH]DEPARTMENT ZC) <br /> 3Q4 E Weber-Ave 3"1 Floor Stockton,CA 95205 <br /> (209) 468-3420 Fax: (209)464-0138 Web:www.co.san joagtnn-va-us/ehd <br /> PUS XC ECOP,DS RELEASE APPLICATION <br /> gU9►NESSIAGENCY: <br /> APPLICANT' 4f A\ <br /> ADDRESS: <br /> I ,4 FACSIMILE: <br /> PHONE. <br /> ' <br /> Time, <br /> TENTATNE'APPOINTMENT Dart: <br /> (pleas®allow 10 business days from data of applicstion submttao <br /> CHECK(30X 70 EXPEDrM REQUEST-(91.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS 1 a( f <br /> _ DATE <br /> SIGNATURE OF APPLICANT "� <br /> Department Use Only <br /> UNIT <br /> FILE ADDRESS • <br /> Irl e.f '., rf �:" ; ❑ Unit 1 P <br /> ty <br /> 2. Weep �►►) N ci � L r r= I ",Unit 2y <br /> e +!� <br /> • q N.WvtSV'f�• � G �.;tias• '��•'�: ;:s•,..t ,7 '! «t.•r �\Q <br /> x j`!rl )�r� Unit 3 1 <br /> s. sues Unit 4 <br /> T. 6"6 E o ew -a sjkn { <br /> sum 1 i �tfl A '-',) ,` ❑ Units <br /> -ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ HOUSING ABATEMENT im SouD WASTE FACILrrY <br /> �4 UNDERGROUND TANK(UST)CLEANUP SITE(L.OP) ❑ FOOD FACILrrY ❑ SOLID WASTE l/EH1C1� <br /> 9 OTHER CLEANUP Sr IV(NON-LOP) d DOG KF-NNEL ig DAIRY 1 <br /> fA UNDERGROUND TANK(MONrrORINGMEMOVAL) D MCKEN RANCH jip,pKG TREATMENT PLANT <br /> e; RkZARDOUS WASTE GENERATOR ❑ MOTELA-IOTF�L 0 PUMPERTRUCKIYARAICHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY p pooL/SPA a LAND USE APPLICATION SITES <br /> ❑ TATTWISODY PIERCING 0 OTHER(PLEASE SYI;CIFY) <br /> O MEDICAL WASTE FACILITY t above by checking <br /> List up to ten addresses in the space above. Select the type(s) of-files from the lis <br /> the appropriate box(es). At least orae file type MUST be selected. Fax to 209 464-0138 or mail to the <br /> 1• <br /> address indicated above. ointment for review will be confirmed <br /> 2, EHD will notify the app (cant if any EHD files <br /> exist An app <br /> approximately five business days but no later than ten (10) days ts shou dpt of pbe lication. ThsschedvledhtQs <br /> will be held for a maximum of five business days for review. Appointmen <br /> accordingly. <br /> 3, A file that is actively being worked on by EHD staff may not be immediately available for review. nem <br /> application may be submitted when the file is available. <br /> n a$released Will be by EHD staff at the 4• Any file not returned int a same ws by the same applicant may requinditJo reZed a$93.00 deposit prior to ev view <br /> or the applicant. Futurefile <br /> 5 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> g, Applications received after 3:00 pm Will be processed the next business day. <br /> GUNFI,R.,ME+D i4PP�iNTiVl1=•N'T"pP.TE� :r :.�X, :•.�:�: <br /> •-;pH014E FAX 1: •; ;a N A1=S : <br /> DATEGONFIRMEC) <br /> REVIEWED YES NO REVlt=V1t DATE <br /> E140 4442-90G - <br /> smar2003 <br />