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DA"i'c RECEIVEp <br /> _ SAN JOAQUIN COUNTY � r.rlu w(Lj <br /> EN 1RONMEN.CA.L HEALTI3.DIi PAR <br /> TIViENZ <br /> 304E Weber Ave 3'd Floor Stockton, CA 95205 <br /> NOV 1 4 2003 (209) 448-3420 Fax; (209) 464-0138 Web. www.co,san-j0agU1n.ca.Us ehd <br /> n'\/iRt.flMtfvi HEtiLTH <br /> C PUBLIC X2:1✓COYWS RELEASE APPLICATION <br /> APPLICANT: ' 0 HUSINESSIAGENCY: w <br /> ADDRESS: d d{ <br /> PHONE: FACS IMILE: r J/ <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Phase allow 10 business days front dale of application submittal) <br /> ED CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQuvS PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE /l � y <br /> DO"dniellt Use Only <br /> ! 1LE ADDRESS IT <br /> 1- SV 1 <br /> r <br /> w <br /> ?. freer <br /> cq Unit I <br /> a. Sheet ll� <br /> k StreetGI f Unit <br /> 5. Slrcel til <br /> t t, <br /> s. street est Unit \�L <br /> 7 3lrrcl /-+ '7 1"l/ Cq 7Ivl� <br /> 8. Street `?..,X_?� /U ��I�c-� I c l'��Gi Glr �� •3 U <br /> )O <br /> �o, sheet .7 - at_ Unit 5 <br /> � ENVIRONMEN_TAALL. HEALTH DEPARTMENT FILES <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) f" HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> �THER CLEANUP SITE(NON-LOP) I'FOOD FACILITY O SOLID WASTE VEHICLE <br /> ERGROUND TANK(MONITORING/REMOVAL) Q DOG KENNEL 0 DAJRY <br /> rIAZARDOUS WASTE GENERATOR C3 CHICKEN RANCH ❑ PK TREATMENT PLANT <br /> TIIERED P5RMJTTED FACILITY 0 MOTELIHOTEL OP,,PVMPER TRUCKIrYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING 0 POOUSPA JVLAND USE APPLICATION SITES <br /> El MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> I. 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 least one file type MUST be selected. Fax to(2179)464-0138 or mail to the <br /> address indicated above. --- <br /> 2, EHD will notify the applicant if any EHD files 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 be 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 /> application may be submitted when the file 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 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. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX IN1T1ALS <br /> REVIEWED YES NO REVIEW DATE <br /> `MD 44-02.aor <br /> luarzooa <br />