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SAN X 'JUIN COUNTYPUBLIC HEALTH SER' S <br />MRONMENTAL, HEAL'rH DIVISION <br />304 F_A$T WEBER AVENUE, THIRD FLOOR <br />C (/ STOG KION CA 95202 <br />(209) 468-3420 <br />PUBLIC RECORDS RP -LEASE APPLICATION _ <br />APP�1GAtFr 1 t r♦ V+[r _ 6USIIAF5 AGENCY t NoCo <br />Ar=2ft SSib� Svl :Z 'Sl -b b N ,g <br />?HOME_ Q3`+µ- 't) FACSIMILE a S38 <br />v <br />f <br />TENTATIVE* APPOJNTMrr NT DATE Twdj� <br />(Plemo ylva 710 10 t71n7l;)a5 clays horn tla:a of eppttcnt.ori submtttxl) <br />E7 CHECK EQX T4 ExPF-RITE REQVEST 3 7.0 F" -REQUEST PROIIE33Q IN � BUSIN"S DAY5 O r n <br />SiGNATUPkE OF APPUCANT DATE t7 16 0 l/ J 1 <br />m a <br />• <br />PROGRAM <br />a, <br />V <br />i <br />ENVIRONMENYAL HEALTH DIVISION BILES <br />10 <br />r <br />UNOrRGROUND TANK (UST) CLEANUP SITE (t,OPI CI H DUS ING ABATEMENT Jed SOLID WASTE FACILITY <br />jxt OTHER CLEANQP $jl (NQN-LOP) 0 FOW FACILITY O $0) -to WASTE VEHICU <br />.i.pERGR¢URtJ TANK (MON ITORiht xfMMOVAL) 0 1'R6 KENNEL ;UC O Ity <br />HAZAFUDOU& WASTE OPNtCr?;ATOR 'X�cR)GKEN RANGH n PKG TREATMENT PLANT' <br />o 7LEREG PERMITTED FAC:I.7TY 0 tAMLMOTEL 0 PUMPER TRUCKlYARO/CHEM TC4LETS <br />C3 -TA'U00 ODY PEIRCtNG D POOL15PA - D LAND USE APFLICATION SITES <br />Pf-MSDtC:At,wAS 1Z FACILITY ❑ PUBLIC WATERSYSTEb1 Ct OTHER (PLLASE SPECIFY ABOVE) <br />'l. List Lip to ten .addres:.aa In the space abavc. Select the types) of tiles from the lWt move by Decking <br />the appropriatR bgx(es), ,At least one fit* type MI1$T 40 $2140tad. Eax to (;491-164-0136 or mail to thq <br />addrmr5 IndicatedaDon <br />2, EHD will notify the applicant if any EHP floc exist, An appointment for review will be confirmed <br />apprOxintately five business days but no tater than ten (10) days after rec0lpt of appli"tion, The tiles <br />Witt be held fw' a maximum Of five gUGines.s dayS for review. Appvintmanta Should be scheduled <br />accordingly. <br />3. A file 0131 is actively bein.s worked on by END staff may not be immediately avail,abla for review. A new <br />ApplicatiOn may bC Submitted when the 1110 Is avaliole. <br />4. Any file nUt returned in the $Am* condition: as released will be reorganized by EHD Atbff at the expense <br />of the applicant, f=uture fila reviews by the same applicant may require a $97.00 deposit prior to review. <br />5. "TENTATIVE appointment dates must be COAfirMed with EHD staff. <br />6, AppliCatlons received after 3:00 pm will he processed tete next business day. <br />CONFIRMED APPOINTMENT DAiE TWE <br />DATE CONFIRMED PHQNE FAX INITIALS <br />REVIEWED YES NO <br />REVIEW fJATiE <br />TQTAL P.32 <br />