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DATE REC51V�-o FHD LOG NUMBER <br /> SAN .70A.QUIN COUNTY <br /> EN'VIRON)IENI'A.L HEALTH REPA.RTMEINT <br /> 304 E Weber Ave 3`l Floor Stockton, CA 95205 <br /> (209) 46$-3420 Fax: (209) 464-0138 Web: www,co.san jvaquin.ca,u e24 <br /> PUBLIC RECORDS RCI LEASE APPLICATION <br /> APPLICANT: ��,1�• .4.L_, BUSINESSIAGENCY: �rJl-� + 741S16"-<, <br /> ADDRESS: Cf0 Z— <br /> PHONE: FACSIMILE: Z- d <br /> TENTATIVE*APPOINTMENT DATE: Time:4L u <br /> o �� <br /> (Please allow 10 business days from data of application I <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCES z U DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Dcpartmenl Use Only <br /> �� -uhMl �� �.•Q•y�—_ tM�T�S/�(„4 ("j �{F�ILE AI DDlRw 5 5 I <br /> - \ [ UNIT <br /> IvRS hw(DI U7 <br /> 1 <br /> Ftc I <br /> El Unit <br /> ni <br /> SIrnr! 6 2 <br /> n.t <br /> nit <br /> SIrCrl 5 +T cc • 0A Unit 3 <br /> K. Streel N1` A�+`�iJti'� , Ka <br /> 1rrr,9t d S P-4V. <br /> b I S 6 <br /> �\\ scree! y'`��. (�(� .. 1 I _ pl 166 I/ Unit 4 <br /> Slrrrl '2 1 d 6 ,4.q'�`�4.5,e-, k= LA Sk" <br /> RA.nA >;s I [] Unit 5 <br /> i• 3tn(o3 reA-12 .Ir <br /> ENVIRONME 'q H l TH DE t IN F� <br /> i8L UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON�LOP) ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br /> ?�1 UNDERGROUND TANK(MON ITORINGIREMOVALr/ O DOG KENNEL ❑ DAIRY <br /> �l HAZARDOUS WASTE GENERATOR-" O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY✓- rlont- © MOTEIJHOTEL Q PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING 0 POOLJSPA O LAND USE APPLICATION SITES <br /> Gl MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt of application, The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3_ A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONE`IPMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> PHO 49.02.006 �•'�'" J" <br /> 919�Z00 <br />