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SUP — 1 1 — 03 THU 1 3 = 57 I r-1 T_ 4-- r- HOLT_ i onaa I Geo I o9 i c P _ 0 � <br /> EHD LOU NUMULH <br /> TRp.myg SAN JOAQUIN COUNTY <br /> rRIED <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SEP 1 1 200304 E Wcber Ave 3r°Floor Stockton, CA 95205 <br /> ( 09)468-3420 Fax- (209) 464-0138 Web: www.co,.san-joaquin.ca.us/ehd <br /> 1_P1V1RufdMENI* HEALTH <br /> PERMMSERVICES PUBLIC RECARAS RELEASE APPLICATION <br /> (f �o ! d1r1 NCY: EF`vSIZ <br /> APPLICANT. BUSINESS/AGE <br /> _4�5c <br /> ADDRESS: <br /> PHONE: `51 j?) s FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: \ <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST•$93,000 FEE-REQUEST P ESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT cy It DATE <br /> �+' <br /> Department Use OMY <br /> FILE ADDRESS UNIT <br /> I Wr s(•l P G Unit 1 <br /> d r tf!t -city <br /> / cl . II 13Unit 2 � <br /> tt <br /> s areal __ d Unit 3 1 U <br /> 8. Sirost ^_,_._ .._._._.. G <br /> s„ , AUDM4 <br /> ty <br /> e. � <br /> 9 sues, --- - _.. c ❑ Unit 5 <br /> 10. <br /> G <br /> StfAK <br /> ay <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> D,I'OTHER CLEANUP 517E(NON-LOP) O FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> W,*VNDERGROUND TANK(MONIi'ORINGIREMOVAL) M DOG KENNEL 0 DAIRY <br /> gr HAZARDOUS WASTE GENERATOR O CHICKEN RANCH, 0 PKG TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY 0 MOYELIHOTEL O PUMPER TRUCKiYARDICHEM TOILETS <br /> O TATTOOIBODY PIERCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> D MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIList uFY) <br /> he <br /> om <br /> e list aboyo <br /> checkin <br /> 1 he a p ropriate box(s) Atto ton addresses In tleast he onfile type MUST ace aove. Select tbe selected.f Flax-to 09)464-0138 or ma 1 to hie9 <br /> Pp <br /> addre s indicated above, y ointment for review will be confirmed <br /> 2. EHD will notify the applicant if an EHD files exist. An app <br /> approximately five business days but no later than ten (10) days after <br /> r Appointments should shoult of d be tion. The series <br /> will be hold for a maximum of live business days for review. App <br /> accordingly. <br /> 3. A file that is actively when the f)a iEHD <br /> s avaltabie.may not be immediately available for review. A rev <br /> application may be submitted <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expenss <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to roviev <br /> 5• 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> +3. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE - 'TIME <br /> DATE CONFIRMED <br /> PHONE FAX INITIALS <br /> RE)AEWED YES NO REVIEW DATE <br /> M 44424” <br /> ereRoca <br />