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Z11/02/2004 10:04 9168610130 SECOR PAGE 02/0 <br /> _$ 01/2004 15: 10 4646 ENVIP0NMEMTAL*LTH PAGE 01 <br /> DATE RECEIVED END LAG NUMBER <br /> �. AN JOAQUIN COUNTY <br /> lnjUDI"VIB0) TENTAL HEALTH AE??.4RTMNT <br /> 304 E Weber Ave 3`a Floor Stockton,CA 95205 <br /> NOV 0 2 M409)468-3420 Fax: (209)464-0138 Web:www.co.s=-joaquin.ca.Wehd <br /> ENARONMIENI HEALTH PUBLIC RECOPLIS RELEASE APPLICATION <br /> APPLICANT: U h .. ausINESS7ACENCY: .v=`C?7' i'���✓rlc�i <br /> ADDRESS' <br /> PHONE: (07I 0\\ 8( LCL FACSIMILE: (qi L0) p AI` ✓JYs. <br /> o <br /> TENTATIVE"APPOINTMENT DATE: JI"S py Tkarp: Q .'UUCtr�+-, Vi <br /> (Pica--w;allow 10 busin"s days from date of appflowtion wbmitta0 <br /> CHECK BOX TO EXPEDITE REgv6ST $99.3.-00 F1EE-REQUE-S'T PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �\ W DATE <br /> ponartrnant Use Only <br /> F LE ADORESS I UNI <br /> z �'ac• C by CA 3a5rr 5 t <br /> Z s Z P :' c lFv� 54o �3 as <br /> a „ " P /av aP/ 9 nl(2 <br /> a.• 00, a 1-FL/R- h LA /" Z) <br /> 5. / G- ` UnR 3 <br /> POC <br /> a std ern e <br /> �cXdw-i C4 KI <br /> s. scree Sa 1 L r h ✓I <br /> �o. sere �D LrH( ✓i L'caOttS ✓L <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> A(UNDERGROUND TANK(UST)CLEANUP StrE(LOP) 0 HOUSING ABATEMENT 13 SOLID WASTE FACILITY <br /> �w y <br /> 0 OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY O SOLID WASTE VEHICLE <br /> lam UNDERGROUND TANK'(ypNROMGMjMOVAL) O DOG K!"EL O DAIRY <br /> 2r HAZARDOUS WASTE GENERATOR O CHICKEN RANCH rl PKs TREATMENTPLANT <br /> d 71ERED PERMITTED FAGn.m O MOTELIHOTEL. M PUMPER TRUCW RD?CMFM TO1FTS <br /> E3TATTOOM6DY PIERCING C POOUJSPA .F�iAND USE APpLiCATroN SrrF.9 <br /> ❑ MEDICAL WASTE FACILITY 0 oTHER'(PLFASESPECIF'f) <br /> 1. List up to ten addresses in the space above. Select the fypeils)of files from the list aboye by checking <br /> the appropriate box(es). At least one file type MUST be selected Fax.to(209)464A738 or 9i[to the <br /> address <br /> 2. EHD will indfya <br /> ant If any EHD files extsL An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days after receipt of application. The flies <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 /> 41. 'TENTATIVE appointment dates must be confirmed with£HO staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> 'CONFI�iMFb APPCiIN. NT DALE <br /> TIME w=-77577777777:k <br /> C1A fE COFIIiMEf3 PHONE . FAX 1N11.NdLB <br /> }2£VIEWED L 1 Es NO REVIEW DATE <br /> : s��e-0x wit <br />