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12/28/2003 18:38 9252834 AEI CONSULTANTS '—F) PAGE 01 <br /> EHD LOG NUMBER <br /> DATE RECEIVED 'SAN JOAQUM COUNTY <br /> ENVIRON AFNTAx HEALTH DEPARTMENT <br /> 304 E Weber Ave 3td Floor Stockton,CA 95205 <br /> DEC 3 )468-3420 Fax: (209)4640138 Web:www.co.san Joaquin ca us/ehd <br /> � V jt1,;�v i P1T til ; ; PUBLIC I ECU S RELEASE APPLICATION <br /> APPLICANT: Yl � (i BUS{/Ni:S�SIAGEtN�CY: <br /> ADDRESS: InDf'Ir <br /> PHONE: FACSIMILE: <br /> APPOINTMENT DATE: tR `L�}' Time: l <br /> TENTATIVE M — <br /> (Please allow 10 business days from date of application submittal) <br /> ® CHECK BOX TO EXPEDITE REQUEST 493,00 F F <br /> 1;–REQUEST PROCESSED IN 3 BUSINESS DAYS r <br /> DATE <br /> SIGNATURE OFAPPLICANT <br /> I �� <br /> f' Department Use Only <br /> FILE ADDRESS UNIT <br /> p Unit 1 <br /> "\� 2 Streat t j�f� G 11 <br /> V i1 <br /> 3. Sheet C7 VUnt2 Mb <br /> City- <br /> 4: Sh¢et ISI• W <br /> IVa G a �GL66 HU U61 <br /> s. swot�,r 7, strut 11 �t1CS a IAN _ <br /> 9 2w <br /> `� 6 R Gt +. <br /> 1 t� a ❑ Unit 5 <br /> to. serest •', � Z �. W �c� 2 <br /> Arw <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) U HOUSING ABATEMENT 0,,SOLID WASTE FACILITY <br /> M OTHER CLEANUP SITE(NON-LOP) C] FOOD FACILrrY O SOLID WASTE v9HICLE <br /> DK UNDERGROUND TANK(MONITORINGIREMOVAL) C7 DOG KENNEL ❑ DAIRY <br /> 1 k HAZARDOUS WASTE GENERATOR CI CHICKEN RANCH ❑ PUMPER TREATMENT <br /> PLANT LARD CHEM TOILETS <br /> $I TIERED PERMITTED FACILITY d MOTEUHOTEL <br /> TATTOOIBODY PIERCING 0 POOLISPA' � LAND USE APPLICATfON SrrES <br /> MEDICAL WASTE FACILITY ID OTHER(PLEASE SPECIM <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list aboye by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 202L464-0738 or mail to the <br /> address indicated above. <br /> 2. EHD 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 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 ne• <br /> application may be 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 expens <br /> of the applicant Future file reviews by the same applicant may require a$93.00 deposit prior to revie <br /> S. "'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the neat business day. <br /> 'CONFIRMED.. APPb6NTMENT.15ATE <br /> DATE CONI=IRMED -' :7,HONE fAX <br /> REVIEW DATE <br /> REVIEWED � . 'YES N® <br /> ' EMD4842-0DQ _ ,I <br />