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NOV. 17. 2004_ 9:31AM C "4)OR EARTH TECH NO. 790E P. 1 <br /> y' 1rr 4L l4 J <br /> ��,R�EIVED �� �- - EHD LOG NUMBER <br /> I1 ' SAN JOAQ'Ul1i T COUNTY <br /> 7 2004 EI NYIRoNmmNTAL HEALTH DEPARTmzNT <br /> 304 E Weber Ave P Floor Stockton,CA 95205 <br /> 468-3420 Fax: (209)464-0138 Web;-yi-mv.ro.sati-joaquin.ca.us/chd <br /> pUBLIC RFCOR DS RELEASE APPLICATION <br /> APPLICANT; Z,.,;# BUSINES81AGENCY: COh,10Y <br /> --- <br /> ADDRESS: JAS >�'s'c�.vt1G l,t�a.5� friyG�� sw..-�•G .�� 5-16cL-f0Y+�r C o_(a_._ . <br /> PHONF• 40f) 21-'°i c s I FACSIMILE <br /> TENTATIVE'APPofNTmr=NT DATE: i 2 b l2 arm T,=- `j-a0 A M <br /> (Plow*allow 14 busInesa days from date of application subrr Mal) <br /> CHECK BOX TO EXPEDITE REQUEST-U1. r EE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> i 5 o N. -5 <br /> ❑ Unit 1 <br /> a. 6'."11030 S- U)t v GIY i t1} _ r_: J Unit 2 <br /> d. sye� arm s. M�1�n� a <br /> y- WIN <br /> e. Strne. -1 D O 9 - Kko-i h GI V rr. <br /> e . Mai r. Gl Unit 4t,' <br /> a. sues. 0 5 5 t✓'. <br /> e. svea 5 I t (� i�ctrri ai ^r ❑ Unit 5 <br /> 30. SVeB1 G —S`� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT V SOLID WASTE FACILITY <br /> W OTHER CLEANUP SITE(HON-LOP) 13 FOOD FAGILrfY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONTrORINGIREMOVAL) E3 1)0G KENNEL CI DAIRY <br /> ,;�C HAZARDOUS WASTE GENERATOR O CHICKEN RANCH 'j EJ PKG TREATMENT PLANT <br /> �C TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> t3 TATTOOIBODY PIERCING C7 POOL/SPA `ELAND USE APPLICATION SITES <br /> Q MEDICAI,WASTE FACILITY 13 OTHER(PLEASE SPECIFY) <br /> 1. 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. Fax to(209)464-0138 Or mail to the <br /> address indicated above. <br /> 2. EHD will notriy the applicant If any EMD fifes exist. An appointmentfor 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 /> A fl!;that Is actively being wanted on by END staff may not be immediately available for review. A new <br /> 3. 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 expense <br /> of the applicant. Future pie reviews by the same applicant may require a$93.00 deposit prior to review. <br /> G. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next bue-iness day. <br /> MIT <br /> •gfoas-ox-0oe . <br /> erarmos <br /> i <br /> �I <br />