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.1 '02 FRI 13:45 FAX 19259469968 ERMWEST WC <br />4P SAN J UIN COUNTyPU LIC HEALTH SERVICES <br />5t? VIRONMENTL HEALTH DIViSI®N <br />304 EAST WEBER AVENUE, THIRD FLOOR ' <br />STOCKTON CA 95202 <br />PUBLIC RECQR S 9) 468.3420 <br />RELEASE APPLICATinni <br />�BUSINESSIAGENCy <br />s <br />,' ' <br />04002 <br />Elty %aa Num'a' <br />NOV 0 12002 <br />PHONE Fnfl <br />FAdSIMILE <br />TIME <br />(Pt -as- 91-11P 7 to IV 0P frotKte or jaipplication <br />C] CHECK Uit .. ` , <br />c• <br />QOe • <br />SIGNATURE OF <br />rr <br />EALTH <br />'JES <br />J <br />9 <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />As UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />.� OTHER CLEANUP SITE (NON4L.Op) <br />34 UNDERGROUND *ANK (MONITORiNGIREMOVAL) <br />)� HAZARDOUS WASTE GENERATOR <br />D TiE"D PERMnTED FACILITY <br />❑ TATTOO/BODY PEIRCING <br />d MEDICAL WASTE FACiLI Y <br />3. <br />4. <br />5. <br />.6. <br />® HOUSING ABATEMENT <br />CI FOOD FACILITY <br />❑ SOLID WASTE FAciLITY <br />d 000 KENNEL <br />® SOLID WASTE VEHICLE <br />O DAIRY <br />17 CHICKEN RANCH <br />E3 MOTiELMOTEL <br />O PKG TREATMENT PLANT <br />d POOLISPA <br />13 PUMPER TRUCKIYARbiCHHM TOILETS <br />0 LAND USE APPLICATION srTES <br />X PUBLIC WATER, SYSTEM <br />❑ OTHER (PLEASE SPECIFY A10OVE) <br />List up to tan addresses in the space above. Select the types) of files from the list above by checking <br />the approprlato box(es). At least one file type MUST be selected. Fax to (209} 4t�4-013$„9r mail to the <br />address ind(e'�,ted above <br />will the applicant if any <br />app EHD fllas exist. An appointment for review will be confirmed <br />approximately five businass days but no later than ton (10) days after receipt of application. Tho files <br />Will ba held for a maximum of five'business days for review. ,Appointments should be scheduled <br />accordingly. <br />A file that,)s actively being worked on by EHD staff may not bo Immediately available for review. A new <br />application may be submitted when the file is available. <br />Any file not roturnad itl the same condition as released will be reorganized by EMD start at the expanse <br />of the applicant, Futuro file reviews by the same applicant may require a $89.00 deposit prior to review. <br />'TENTATIVE appointment dates must be confirmed with END staff. <br />Applicatibns received after 3:00 pm will be processed the next business'day. <br />DATE. TIME <br />PHONEDATE CONFIRAdED <br />