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P1) <br />06/24/2004 16:22 <br />CLAYT , GROUP 4 12094640138 <br />tiU„V„o ENVIRONMENTAL CH <br />DAYS RECEIVED SAN JOAQUIN COUNTY <br />j }���I,fJI;\4�' E J ENVIRONMENTAL ItFuLTH DEPARTMENT <br />304 E Weber Ave'3Y�`Tloor.StocktoTt,;CA,95205 <br />,JUN 2 &40418-3420 Fax: (209) 464-0138 Web: wvvw.00.$aj3-j0aqUin.ca.us/ehd <br />Ei`IT HEF�L►H <br />XC RECORDS <br />RELEASE APPLICATION <br />N0.659 D0 <br />PAGE 02 <br />tMIJ LUU NUMOC <br />APPLiGANT: <br />eusiNi=SSIAGIENCY: <br />Q o �Q <br />AvaRSss:p 1, <br />''�• NONE tt� y+�°'fa to 9 . FACSIMILE: <br />TENTATIVE” APPOINTMENT DATE: <br />Time: <br />(Please /plow 1a buslne9s days from data of application submittal) <br />Q CHECK BOX TO EXPEtJITt: REQUEST - 593.00 F E — REQUEST PROCESSE BUSINESS DAYS � <br />DATdor E 2 <br />SIGNATURE OF APPUCANT �� geD3rtment Use Only <br />Uri <br />Unit 3 a� <br />p Unit 5 <br />❑ HOUSING ABATEMENT �OLiD WASTE FACILITY <br />49 -UNDERGROUND TANK (UST) CLEANUP SITE (LOP) la FOOD FACILITY ❑ SOLID WASTE VEHICLS o <br />WOTHER CLEANUP SITE (NON -1.0p) C3DOG KENNEL 0 DAIRY 7 <br />g4NDERGROUND TANK (MONITORINGIREMOVAL-) t7 CHICKEN RANCH r3PKG TRr:ATmr:NT PLANT <br />TrKAZARDQUS WASTE GENERATOR 0 MoMLMOTEL D PANDERPi PPLICATION T 70,LETS <br />P- TIERED PERMI'gfD FAGILITY 0 POOUSPA ❑ ►hND USE= PLtCATit?N $LYES <br />* TATrOOMODY PIERCING THL"aR (t'E-EA9E SPEGEF`n <br />O ME[iICAi. WASTE FACILITY <br />List u to ten addresses in the space abOVO- Select the typ®(sj of FlaXs °209 Chockinge list aboy9 by <br />M 464.01313 o mat to tha <br />1. <br />the appropriate box(es). At least one file type MUST be SelOcted <br />add ®S5 Indic t0 bOVe ointment fOr review will be cortifitTtled <br />2. END will notify the applicant if any EHD files exist. An appointment <br />approximately five business days but no later than ten (10} days ae S�au,apbe scheduled <br />�df`;� <br />w11i be n®Id for a maximum of five busiripss days for review. Appointments <br />ill beaccorhold not be immediately available for review. A new <br />3. A file that is actively being worked on by END staff m y 4 <br />application may be submitted when the File is available. END <br />staff at the expense <br />4, Any lila not returned in the same condition as releasediWiii be roorganized by <br />Af y fl applicant. Future file jAviews by the same applicant may require a $93.00 deposit Prior to mvlew <br />5• "TENTATIVE nt. Future <br />dates must be confirmed with E1HD staff. <br />6. Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMEQ APPOINTMENT DATE <br />DATE CONFIRMED PHONE <br />Laos <br />YES <br />TIME <br />FAX INITiALS _-----,-� <br />REVIEW DATE <br />:A-aLf' <br />