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TH TECHNOLOGIES No .4879 0tnU�u <br /> Sep . 4. 2003 12 43°M CON[ EARG NUN <br /> DAIS.AN JOAQUIN COUNTY <br /> ii;`�l! [j•` EIYVIRONiV�ENTAL H.FALTFI DEPARTMI�TT <br /> i <br /> 304 E Weber Ave 3'Floor Stockton, C.A. 95205 <br /> SEP (1 4 2RGD9) 468.3420 Fay:: (209) 464-0138 Web: www.co-saa-joa-quixl.mus/ehd <br /> mil;jidPMNT r1EHLTi1 p `BLYC RECORDS RELEASE APPLZCAUON �. <br /> S .411 <br /> SUSiNESSIAGENCY: <br /> APPLICANT: T <br /> ADDRESS: g� T� , - �� :ST- �ToG�T0 <br /> (11 <br /> PLION � FACSIMILE: � � ' <br /> TENTATIVE'APPOINTMENT DATE. 1 57 <br /> (Pleus.e allow 10 business days from date of applie atlon submittal) <br /> CHECK BOX TO EXPEDITE R£QUPS __$83.ao FEE—REQUEST ROCESSEIa IN 3 BUSINESS DAYS O� <br /> SIGNATURE OF APPLICANT cC PATE <br /> Department Uae Only <br /> UNIT <br /> FILE ADDRESS <br /> ,. 5iao w• }�Jr-t� ci c -tor ❑ Unit <br /> z sv� rri __ t C /$ Unit 2 <br /> Unit 3 <br /> — <br /> a t 55 nit 4 <br /> 0 3 v1 l G <br /> n. sant ;�Init 5 <br /> S. Skirt <br /> 7 - <br /> Ci <br /> 10, 5 / <br /> ENVIR NMENTAL.HEALTH OF-PARTMENT FILES <br /> ❑ HOUSING ABATEMENT Ik SOL.ID WASTE FACII-ny <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY V SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ DOS;KENNET. ❑ DAIRY <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 4� HAZARDOUS WASTE GENERATOR ❑ MOTEL/HOTEL 0 pUMPER TRUCK/YARD/CHEM TOILETS <br /> TIERED PERMITTED FACILITY L7 POOL/SPA 1W LAND USE APPLICATION SITES <br /> 0 TATTOOfSODY PIERCING <br /> MEDICAL.WASTE FACILITY <br /> 11 OTHER(PLEAS4PFrs�`n <br /> st aboye by checking <br /> 1. List up to ten addresses in the spa pI D I A138 or mail to the <br /> the appropriate box(es). At least o o <br /> address indipated above_ be confirmed <br /> 2. EHD will notify the applicant if any (plication. The files <br /> approximately five business days t J be scheduled <br /> will be held for a maximum Of five t <br /> accordingly. Ile for review. A ne, <br /> 3. A file that is actively being worked 4 <br /> application may be submitted when staff at the expens <br /> 4. Any file not returned in the same co ,posit prior to reviW <br /> of the applicant. Future file reviews <br /> S. 'TENTATIVE appointment dates mu: <br /> 6. Applications received after 3:00 pm <br /> CONFIRMED APPOINTMENT GATE <br /> DATE CONFIRMED <br /> REVIEWED YES NO REVIEW DATF-' <br /> END 41AM" <br />