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06/06/2007 WED 15:36 FAX 20QIA682999 SJC PUBLIC WORKS 001/002 <br /> DATE RECEIVED PHl7 LOG NUMBED <br /> �� SAN JOAQUIN COUNTY <br /> i <br /> R E C F�`'IED ENVIRONMENTAL <br /> 4 EC31�MENTAL HEALTH DEPARTMENT <br /> Weiner Ave P Moor Stockton,GA 95205 <br /> JUN 0 208-3420 Tax: (209)464-0138 Web: WWw.co.san-joaquin.ca.us/eh <br /> I4� LIC]RECORDS LEASE APPLICA170N <br /> APPLICAWNrlIV.i�nc�i�k tScmberI i n9 BUSINCSSIAGENCY: Sari Joaquin County Public Works Department <br /> ADDRESS: 1810 E. Hazelton Avenue, Stockton, California 95205 <br /> PHONE; 953-7624 FACSIMILE: 468-2999 <br /> TENTATIVE*APPOINTMENT DATE! TIInu <br /> (Please allow 10 business days from data of application submittal) <br /> rl CHECK SOX TO EXPEDITE REQUEST-*93,00 PEE--REQUEST PROCESSED IN 3 BUSINESS DAYS + 1 r� <br /> SIGNATURE OF APPLICANT d�c� k • ' C7AT1= Ili" tri—1 f <br /> Department Usa Only <br /> PILE ADDRESS UNIT <br /> ppo .S. ' b v c <br /> 2. s".t q4,07 G ❑ Unit 1 <br /> 3. SVaet 'fl1li`4` cit Unit 2 <br /> ,7 Ci <br /> lAr e. stet <br /> CA Unit <br /> C' Unit 4 <br /> &. SOW( CSt - - <br /> stoma j �t ❑ unit 5 <br /> to, ste9t 1t'I� IYLI4p�+ Yt ca <br /> ENVIRONMENTAL HEALTH DEPARTMENT FIDES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 171 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) C3 FOOD PACILITY III SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONrroRINGMEMOVAL.y ❑ DOG KENNEL El DAIRY <br /> HAZARDOUS WASTE GENERATOR C7 CHICKEN RANCH Cl PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 1j MOTF-UHOTEL Ca PUMPER TRUG"ARDICHEM TOILETS <br /> TATTOOISODY PIERCING Ea POOLtSPA ❑ LAND USE APPLICATION SITES <br /> o MEDICAL WASTE FACILITY Q OTHER(PLEASE SPECIFY) <br /> 1. List up to ken addresses in the Space above. Select the type($)of files from the list above by checking',,, <br /> the appropriate box(es). At least one file type MUST be selected. i~ x to 209 4g4M0138 or mall 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 r <br /> accordingly. <br /> 3. A file that is actively being wo4ked on by EHO 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$9.3.00 deposit prior to review, <br /> 5, *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 Pitt Will be processed tate next business day. <br /> C3 MRo "FtTTd13N <br /> - N9cIME <br /> :bA"F a11~IITIA x <br /> n...__ [ ted . .. .r: .; r .. <br /> FKo 042-M ...:.,,... ..,..._..u.,..., <br />