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Q002 <br /> 10!28/2004 13:24 FAX 209 948' <br /> DA - RECEIVED SAN JOAQUIN COUNTY <br /> 'NyMONMENFA.L HEALTH DEPARTMENT <br /> 304 E Weber Ave 31d Floor Stockton,CA 95205 <br /> (209) 468-3420 Fax: (209)464-0138'Web: wr <br /> ww.co.san joaquin.mus/ehd <br /> pTjBLXC UCQRDS RELEASE Al'pLXCATIQN <br /> APPUCANT: t rsv- <br /> s5i.h gUSWESSlAGENCY: <br /> dt <br /> ejA <br /> ADDRESS: i �?,yr f1� `, vim':t• .k1 ter, <br /> PHONE- <br /> ti�/ < FACSIMILE: <br /> • rune: 1Z;a— <br /> TENTAT W APPOINTMENT DAIt: <br /> (Pkoase allow 10 business days from data of application submiMl) <br /> CHECK BOX TO EXPEDITE REQUEST.$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS I T, � <br /> DATE <br /> SIGNATURE 05 APPLICANT �•r _ peva,tnene use only <br /> UNIT <br /> FILE ADDRESS <br /> Unit 1 <br /> 2. saee� \ G �:,� Unit 2I oy, <br /> k v4 . : t` Unit 3 1 <br /> 6, <br /> s� u►oo ' 22 Unit 4 <br /> sued IT, <br /> 1 t ''tA �4 �¢ r ❑ Unit 5 <br /> W <br /> G � <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ HOUSING ABATEMENY $1 SOLID WASTE FE:141C Y <br /> j& UNDERGROUND TANK ps n CLEANUP SM <br /> (Lop) ❑ FOOD FACILITY ❑ SOL ID WASTE V>~HICt� r <br /> IS OTHER CLEANUP SrM(NON-LOP) d DOG�NNEL 0 DAIRY <br /> Ig UgDERGROUND TANK(MONITORINGMEMOVAL) D CHICKEN RANCH N,pKG TREATMENT PLANT <br /> rg HAZARDOUS WASTE GENERATOR ❑ M ICKrEN M CI pUMPERTRUCKlYARDlCHFM TOILEM <br /> ❑ TIERED pERMrrTED FACILITY C3poOUSPA a. <br /> LAND USI=APPLICATION SITES <br /> ❑ TA-ROOBODy PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY checking <br /> to ten addresses in the space above. Select the type(s)of files from the list aboye by <br /> 1. I ist up MUST be selected. Fax to 209 464-0 l38 or mail to the <br /> the appropriate box(es). At least one ble type <br /> address indicated above. far review will be confirmed <br /> Z EHD will notify the applicant if any EHD files exist An appointmentIlcation. The files <br /> appraztmately five business days but no later than ten(10)days fter should be scheduled <br /> will be held for a maximum of five business days for review. Appointments <br /> accordingly. not be immediately available for review. A neK <br /> • 3, A file that is actively being worked on by EHD staff may <br /> application may be submitted when the 01e is available. <br /> applicant May require a$93.00 deposit prior to review <br /> 4- Any file not returned in the same condition as released will be reorganized by END staff at the expens <br /> of the applicant. Future filo reviews by the same app' Y <br /> appointment dates must be confirmed with EHD staff. <br /> 5. -TENTATIVE <br /> s ed the next businoss day. <br /> 6. Applications received after 3:00 pm will be proce s , <br /> CtNF1,RM�D gppiityTiVINT <br /> T f j <br /> :DAT>r- OT1t=jRMED. <br /> YES Yt10 REVIEW DATE. <br /> REVIEWED <br /> EHn 4a uz aoc <br /> nrsr2oaz <br />