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11/05/2004 16:20 9252E21 _ AEI CONSULTANTPAGE. 02 <br /> REGF;' p f+ � EHD L05 NUMBEI <br /> =, ED SAN Jo.AQUIN COUNTY <br /> �. ._ EN YMON ENTAL REALTR UEPA.RTMMT <br /> 5 2004 304 E Weber Ave 3'4 Floor Stockton,CA 95205 <br /> 0 Fay: (209)454-0138 Web:wwv�r.ro.san�oaquiu ca.usfek�d ZI <br /> { Lj:ifiT/SERVICESP TULIC IMCO"S RELEASE APPLICATION <br /> APPLICANT: i ✓ ilTi 3 BUSINESSIAGENCY(:�� s <br /> ADDRESS: f-eso cw a7 (p U�L�� T f �j. <br /> PHONE: �Q FACSIMILE: ? <br /> TENTATNE"AP OINTMENTDATE: f " "� Time: <br /> ase allow 10 buslne=days from date of epplicaUon submdtat). <br /> r <br /> ti"sr,� r <br /> r CH K BOX T QUEST-$93.00 FEE—REQUEST PROCES'S'ED IN 3 BUSINESS DAYS <br /> SIG U O ; ICANT <br /> DATE 1 l 16.0 <br /> Department Use Only <br /> FILE ADDRESS UNIT � <br /> i� ElUnit 1 <br /> a <br /> a. sveet t�,S+eCrdW c. ►` _ ❑ Unit 2 <br /> {. wast W�• " . <br /> s. succi q1 O rr W 1 Unit 3 <br /> 6. suet! <br /> 7_ stretl <br /> 1` Unita <br /> s. sasat a-� <br /> '5L IJ <br /> `. <br /> s. sNaet O G o t. ❑ Unit 5 <br /> k <br /> �Q. S1L�t <br /> ] <br /> AC <br /> ENVIRONMENTAL HEALTH p f <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABAT � L � X SOLID WASTE FACILTTY <br /> OTHER CLEANUP SI'M(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONMORINGIREMOYAL) ❑ DOG KENNEL 13 DAIRY <br /> HA7ARp0US WASTE GENERATOR a QUCKEN RANCH Q PKG TREATMENT PLANT <br /> TIERED pERMn`TED FACILITY d MOTELlHOiEL d p11MPER7RUCKlYARDICHEiN TOILETS <br /> ❑ TATTOOIBOIDY PIERCING ❑ POOLISPA D LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY LI OTHER(PLEASE SPECK = <br /> 9, <br /> List up to ten addresses in the Space above. Select;the type(s)�of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. [=ax to 308 464-0138 ar rilall to the <br /> address indicated above. <br /> 2. END will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days after receipt of application. The files <br /> will be held for a maxlmum of five business days for review. Appointinents.should be scheduled <br /> accordingly. <br /> 3. Afile that is actively being worked onlay EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is avallable. " <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD Staff at the expense j <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 dep rior to review <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff, 1 <br /> $. Applications received after 3:00 pm will be processed the next business day. <br /> :?IME <br /> CUNF!RMED A Pd NTMENT D''. - <br /> �. /-y■ � p p - -- 4��`PHOfJEJ_ . .;��.._ . _ �tl►triCr/�5:��"��4--_� __.�'-�`•:�`_• ''.•: f} <br /> DATE},V4Ri91•1f U71ED �+ 7 <br /> No REVIEW DAVE :. p <br /> REVIEWED " } <br /> EMU 48-0x046 '3 _ <br /> eras M <br /> W 4 <br />