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3 <br /> 08/2912003 10:23 46413 ENVIRL1r4VENTAL Ho'li PAGE 0:1 <br /> SL P; r 0 SAN JOAQMN COUNTY <br /> AUG 2 9 2003 304 E Weber AVC ata Floor Stockton,CA 95205 <br /> (249)468-3420 Fax:(209)464-0138 Web:vsnvw.co.sanyoaquin ca uslehd <br /> 14 <br /> ENVIRuNIAENT HEALTH PUBLIC CORDS RELEASE APPLXCA.�'ION <br /> PERI�/iIT.�SERVICES <br /> ApMCANT: ,t l 11 G Pt' 6U8(Nf85JAGENCY: <br /> ADDRESS: <br /> C>'7 0 s•AcsiMiLE:,, t o-� <br /> PHONE: _,� -.l <br /> q Time: COPY <br /> a <br /> TENTATIVE~ kvpo1NTMENTDATE:�"e � <br /> ;PWS►allow 10 businvatl days tram tla►t►of appUvrNor rubmltt,f) <br /> cHECK 00x TO EXPEDITE RE"PST•$33.00 FEE-REOUIST PROCESSED IN 3 BUVINr'"DAYSDAXE g 29�� <br /> sIGNATURE OF AppL1CA,N7 04psr"OntUse 0611 <br /> UNIT <br /> FILE ADDRESS <br /> a nit i C <br /> ,. c <br /> z u � Unit - t� <br /> o nit 3 <br /> ° 0Unit 4 ( 4 <br /> a. sxu G ❑ unit 5 sr- <br /> It <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> P$YR ILQp) HOrJ$INQ A9ATEMEt4T ./ "�U WASTE FACiLI?V <br /> C) UNDERGROUND TANK N5T)CLE�xu p FOOD fA ABAT O :SOLO wA9T1!VEHICLe <br /> O MIER CLEANUP SITE(N-K LM p pOp�NNEL 0 t3�3RY <br /> O UNDERGIROUND TANK(MONITOIUNGIR9100VAL) n CHICKEN RANCH n pICG TREATMENT pLIWT <br /> HAZARDOUS WASTE OENFRA70�t n CHICKIAOTEt4 RAN n PUMPERTRUCWYARDICHEM TOILETS <br /> TIERED PdKM17TED FACILITY in POOLMPA O Lj►NO US>:gppttCAltON SSS <br /> C TATTOOMODY PIERCING O OTHER(PLEASS SPECT <br /> ❑ MEDICAL.WASTE FAr-U rY5 b checking <br /> of files from thr�fist abaYe Y <br /> 1, Llst up to tan addresses tAt oast oris flue typo MUST be selected. Fax---�t-- <br /> 464"1 a or mail he <br /> the appropriate boxes) <br /> �ddra«I^cticated above. ointment for review will bli"tionn.Th9 files <br /> 2. EtD will NWY tho applicant if any t3tiD fllss exist An a p da s:after receipt of epA <br /> for review. Appointments should be srhoduled <br /> wI bo held for s,rraximutn of fie businotar ess days n ton( Y <br /> eccordirtgiy. available for review. Anew <br /> g, A{iia that is actively being worked on by EHD staff may not be immediately <br /> EHd stat at the expense <br /> application may be submitted when the file is available- 0 da osit prior to eaviaw• <br /> q, <br /> Any file not returned in.the same condition as raises" <br /> wat may require a$93 p <br /> of the applicant- Future fife reviews by the seine app <br /> *TENTATiYE appointment dates mustbe <br /> b0 Proeess*d Me nextrmad with RHO ness day. <br /> 8, Applications received after 3:00 pm <br /> TIME <br /> CONFIRh1E0 APPOINTMENT DATE {NTFMAL3 <br /> DATE CONFIRMED PHONE <br /> REVIEWED YES NO REVIEW DATE . <br /> was <br />