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11/17/2004 09:40 FAX 209 94809ki X002 <br /> '� �±R; � COUNTY SANJOkQL Cf•1�uv�7.�Nlrluur � <br /> E+NMONWNTAL HEALTH DEPARTMENT -� <br /> 'NOV Z 7 2004 304 E Weber'Ave 3"Floor Stockton, CA 95205 <br /> EfVVIRC?Nl ??F)1 <br /> 1§8-3420 Fax: (209)454-0138 Web:Vr*VW.Co.sau joaquin.mus/ehd <br /> ULJH <br /> ECRMIVSERVICESpLBLICZ13 <br /> MCQRDS RELEASE .APPLICATION <br /> ' .c.. U�ro��.s� susllvEssrAGEr{cr: + ' <br /> a,PpucAri-r• <br /> ADDRESS a r� 4A X33 dam' <br /> PHONE; FAzrSIMILE: <br /> TENTATIVE',p,PPOINTMENT DATE: <br /> (please allow 10 business days frersl date of applic 400 subm tW) <br /> i <br /> CHECK BOX TO EXPEDITE REQUEST-$93-00 FEE—REQUEST PROCESSED IN 3.I3VSIN53S DAYS <br /> SIGNATURE OF APPLICANT ../� DATE <br /> Department Use Oniy <br /> UNrr <br /> FILE ADDRESS Un <br /> it 1 <br /> i.- S1114 Hca Urtzc <br /> 4. Suv% Unit 3 ��✓ <br /> U <br /> i <br /> j <br /> Unit 4 <br /> e:. SMeel - <br /> 9. ❑ Unit 5 <br /> to. sari G <br /> ty <br /> -ENVIRONMENTAL HEALTH.DEPARTMENT FILES <br /> IX UNDERGRQQND TANK NST)CL>`MUP STrt=.(LOP) IJ }LOUSING ABATEMENT tZ.SOLID WASTE FAGIUTY <br /> i OTHER CLEANUP 5rti;(NON-LOP) O FOOD FACILITY Q SCUD WASTE VEHICLE <br /> ID UNDERGROUND TANK(MONITOMt GIREMOVAL) 0 VQ(G KENNEL: IS-DAIRY <br /> 0 GHICKP-N RANCH ZSL PKG TREATMENT PLANT <br /> HAZARDOUS WASTP-GENERATOR 0 MOTEUHOTEL EPUMPER iRUCYARDIC <br /> HEM T <br /> OILETS <br /> O D rD FACILITY 1CAT011 SrrE <br /> 4 TAxrOOIBQnY pi=RCING d PQOLtSPA <br /> C& LAND USE APP.1D <br /> MEDICAL WASTE FACIt ITYE7 OTHER{PLEASE 5PECIM <br /> 1, t List up to tan addresses in the'space above. Select the type(s) of files from the list above by checkinj <br /> the appropriate box(es). At least one file type MUST be selected: Fax to (209)464-0138 or snail to the <br /> address indicated above. <br /> 2. ErHO will notify the applicant if any EHO files exist. An appointment for review will be con firmed <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 1,e immediately available for review. Ane <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 expem <br /> of the appticanL Future Tile reviews by the same applicant may require a$53.00 deposit prior to re0 <br /> 5, 'TENTATIVE appointn'lent dates must be Confirmed with EHD staff. <br /> 6. AFplicatioris received after 3:00 pm Will be processed the next business day. <br /> 14 <br /> 4ENT�11N7 AT ' TIME <br /> i'- <br /> ... ., F } ^..iii •'a... v.. <br /> • •`ti: .. h .A' r; -- • •.1'=~;'';v',�IN�'CIAL•S' - <br /> "DA7E-G4NFIR1VIlwD 1?1�4NE . FAX' - ' <br /> ' .•.' ., : REVIEW DATE <br /> .REVI,EWED ,_ YES No <br /> ' �Ko�aaz•9aB - <br /> rr <br /> } <br />