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k Elio LUG NUMBER <br /> ; SATE RECEIVED IIr <br /> SAN JOA.QUIN COUNTY <br /> E+ NVI �N�►'.>;ENTALHEA.LTHDFPARTMFNT 6 1 � <br /> 304E Weber Ave 3`d Floor Stockton. C" A.95205 <br /> -{2., 45$-3420 Fax: (209)4$4-01.38 Web: www_co_san joaquin.ca.us/thd <br /> � � <br /> tTUBLAC � + G4,RDS RELEASE APPLICATION <br /> APPL1LA1V f � ! S f�CJ�l U" -. RUSINESSIAGENCY: <br /> ADDRESS O2 } <br /> PaN <br /> HONE: FACSIMILE• �v - 22 <br /> TI;NTATIVF-*APPOINTMENT DATE: Time: <br /> (Please allow-70 business days from date of application 5tlbmmai) <br /> 0 CHFCK BDX TO E"XFEb)TE REQUES -$93.4 e E—REQUEST PROCESSED IN 3 13USINESS DAYS <br /> SIGNATURE OF APPLICANT j: DATE �cJf <br /> Department Use only 1 <br /> IFILE ADDR:=SS U141T } <br /> t <br /> ��yyI <br /> its G ' � ^ e� Unit I <br /> 7, Sweet �. '�E� CI �C if rr44 �r <br /> 3, Mimi �. c Unit 2 4ti, <br /> aty <br /> 4, Strcct t ' <br /> 5. st+oN t .4e Unit 3 <br /> e. asreer k `°�` cat <br /> n <br /> T. SAMA <br /> ', ul: cn it <br /> 8, SlrtN �� is ql <br /> e. Srrsal F IL. ❑ Unit 5 <br /> 1 p, 5lreN �E� <br /> ENVIRONMENTAL HEALTH pEpARTMENT FILES <br /> I UNDERGROUND TANK(UST)CLEANUP SIT£(LOP) ❑ HOUSING ABATEMENT t7 SOLtD WASTE FACILITY <br /> t OTHER CLEANUP SITE(NON-LOP) $ !` 0 FOOD FACILITY O SOLID WASTE VBHiCLE <br /> t_id UNDERGROUND TANK(MONITOPINGIREMOVAL) M DOC KENNEL 0 DAIRY <br /> AT_AFi©OUS WASTi=GENERATOR ❑ GIiICK>=N RANCH ❑ PKG TREATMENT PLANT f <br /> TIERED PERhfI1TT D FACILITY ❑ MOTELIHOTE), In PUMPER TRUCKIYARDIcRE t TOILETS <br /> IV I7 TIERED IBODY PIERCING 0 POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICALwA.5TE FACILITY D OTHER,(PLEASE SPECIFY} <br /> T <br /> Yl' e s of files from the list'above•by checking <br /> 1. List up to ten addresses-in the space above. Select the typ ( ) <br /> the appropriate box(es). At(east one file type MUST be selected. Fax to 209)464-0138 or(Alai]to the <br /> address indicated above. confirmed <br /> i ' <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be <br /> approximately five bus-iness days but no later than ten (10) days after receipt of application..The files <br /> will be lield for a maXirnum of five business days for review. Appointments should be scheduled <br /> accordingly ? il,` <br /> 3. A file that is actively being iVotRdd on by EHD staff may not be immediately available for review. Anew <br /> application may be submitted when the file is available. <br /> �4, Any file'inot returned in the'sanie'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 /> g. *TENTATIVE appointment datei 'murt be confirmed'with EHD staff. i <br /> 6. Applications received after 3:00 jpm will be processed the next business.day. <br /> GUNF€RMi=D APPOINTMENT DATE TIM 1l; <br /> DATE CONFIRMED , t_ PHONE FAX." INITIALS <br /> REVIEWED YES � NO,, REVIEW DATE <br /> PHO 4 U-01% - <br /> ersnpea � <br />