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M <br /> DATE I:ECC LVED FHp ECJ(;NUMBS <br /> SAN JOA.QtJI COUNTY <br /> ENVIRONMENTAL HE,ALTU DEPARTMENT <br /> 304 E Weber Ave 3"'Floor Stockton, CA 95205 <br /> (209) 468-3470 Fax: (209)464-0138 Web: www.co.san,_oaquin.ca, e <br /> _ <br /> PUBLICIZE CORDS RELEASE APPLICATION <br /> APPLICANT: 4661, Eaj_4 BUSWESSIA(3ENCY: kpz • .. '� {� --- <br /> ,.k <br /> ADDRESS: ► <br /> �.U� -"f t� <br /> PHONE: I FACSIMILE: . 7;t,q `t <br /> TENTATIVE"APPOINTMENT DATE: A „2- 10 Time: � <br /> (Please allow 10 business days from date of application&VIShl <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PPOCES U DAYS { <br /> SIGNATURE OF APPLICANT DATE (-Z' <br /> Dcoartment Use Only <br /> FILE ADDRMSS UNIT <br /> 1. City ]CC <br /> Unit t <br /> 2. I <br /> 3. <br /> / GIIY 03 <br /> Ut"I.it 2 I <br /> A. Slrr,.ct � 7 V •.S 1-'-p` C.� GII � �U <br /> s. SIrCrl rb �� 1'—+ CityI <br /> R, street l.�u d fes ^' ' cit <br /> 7, $Irrgt 94( - Cll yyrJ <br /> B. Slrecl n .CQ In '(ry Cll <br /> B, Slrrrt :2-1 3� ri�44�5n D�.C� Y'�'� cityUnit 5 <br /> is slroct •2q !yIAL" 'n+ CI <br /> ENVIRONMENTAL_HEALTH DEPARTMENT FILES <br /> bC UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> W OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILJTY E3 SOLID WASTE VEHICLE <br /> IC UNDERGROUND TANK(MONITORINGIRFMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> IC HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCK►YAROMHEM TOILETS <br /> ❑ TATTQ01BODY PIERCING ❑ POOL/SPA O LAND USE APPLICATION SITES j <br /> El MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPF-CIFY) <br /> 1. Fist 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. Fax to 209 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHL] 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 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 be immediately available for review_ A new <br /> appiication maybe 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 expense <br /> of the applicant. Future file reviews by the salve applicant may require a $93.00 deposit prior to review. <br /> 5. `TENTATIVE appointment dates must be confirmed with END staff, <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONE~IPMED PRONE FAX INITIALS <br /> REVIEWED YES NO: REVIEW DATE <br /> FRO 4h•02.006 f" <br /> srsnens <br />