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APR- 29- 2004 3:35PM 0STONE ENV. 714-414-1166 NO. 9424c""P. 2/2"0"�` <br /> .. _ ..� SAN JUAk2UIN %,vvJNTY `s <br /> ED <br /> ENVIRONMENTALIEALTH j?EPARTMENT <br /> U 304 E Weiser Ave P Floor Stockton,CA 95205 <br /> APR 2 9 2 9)468-3420 Fax: (209)464-0138 Web:www.ca.san joaquin.ca.us/ehd <br /> ENViRONIVIENT HEALTH PUBLIC RECOP.DS RELFASE APPLICATION <br /> is7� K BUSNIES81ACrENCY'-�+.r��...�'�i�"t-4- �r��►� ,Me�� <br /> APPLICANT: <br /> ADDRESS: �fv P, tvrvAiLA <br /> PHONE: J <br /> PHONE: <br /> LI 1 I 7--Z- FACSIIUMILE' <br /> tENTATWE•APPOW HENT DATE: TAi1e. <br /> 1pbas0 all w 1 a busirass dap%ftm dWfiR of Mp icatkm submittal) <br /> CHECK Box To EXPEDITE REWEST-$03.00 FEE-REQUESr pROI IN 3 ISUSINESS DAYS <br /> YJ — DATE <br /> SIGNATURE OF APPLICANT Deaart,n of Use G,N <br /> IT <br /> PILE ADDRESS <br /> Unit 7 <br /> ,�IA'� <br /> s. s 2 2 t'asb NA C ❑ Unit 2 <br /> e1 131 '� Aj�)J <br /> sbvd 1%-%] ,,o ` ` g tt unit <br /> tin <br /> a sleet <br /> 7. Sued <br /> c <br /> e. Mad ❑ Unit 5 <br /> a. sr.a <br /> c <br /> ,o. Sfree, <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> d HOUSRIG ABATa TIT LD a SouD WASTE FACILITY <br /> Id UNDER(a'ROUND TANK(UST)CLEANUP SITE(LOP) O FOOD 13 ASC1 SOW ASTF- IEH <br /> VWA E <br /> d OTHER CLEANUP SITE(NON-IAP) G KENNEL C3 DAIRY <br /> d UNDERGROUND TANK(MONIT)RM GmE13 PUUOVAL) NCH O PKG TREAT1MENT PLANT <br /> © DO <br /> W HAZAMxms WASTE GENERATOR CHWAICMMOTIEN RANCH <br /> G PUMPER TRIU <br /> UCYARDICHEM TOILETS <br /> O 0 MOTTIEPED PERMITTED FACILny C] pOOUSPA O LAND USE APPLICATION SITES <br /> E3 TATTOOIBODY PIERCING <br /> O MEDICAL WASTE FACILITY a OTHER(PLEASE SPECIFY) <br /> c <br /> �files from the fist above by checking <br /> 1, List up tv ten addresses in the space above. Select the type(s) 9 �54_"-013S or mail to the <br /> the appropriate box(es). At least one file type MUST be selected. ax <br /> bD address IndicatpgAbOve. appointment for review will be cortflrmed <br /> 2. END will notify the applicant if any EHD files exist An appo application. The files <br /> approximately floe business days but no later than ten(10)days after receipt <br /> Of Vail 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 staffMaynot be immediately available for review. Anew <br /> application may be subrnitWd when the file is available. n,ztid by D staff at the expanse <br /> q. Any file pat rapMmed in the same condition as released itl be mor ire a X83 .00 deposit prior a review. <br /> of the applicant Future file reviews by the same app MAY <br /> 5. *TENTATIVE appoirtttnertt dates must be confirmed with EHD staff. <br /> S. Applications received after 3:0o pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED <br /> PHONE FAX INITIALS , <br /> REVIEWED YES NO REVIEW DATE <br /> e,o.s�aos <br /> r <br />