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DATE RECClVED EHI7 LOG NUMBF_'R <br /> SAN JOA.QU;lN COUNTY 49 <br /> ENVIRONMENTAL HEALTU DEP.ARTMENT <br /> 304 F Weber Ave 3"Floor Stockton, CA95205 <br /> (209) 468-3420 Fax: (209) 464-0138 Web: www.co.san joaduin.ca.0 e2 <br /> PUBLIC RECORDS. .'PIC4 LEASE APPLICATION <br /> APPLICANT: L.c.-'D BUSINESSIAGENCY: ki-N ^t Ac. <br /> ADDRESS: �qq-�y� yZ liyL • r, 1 �I S^ �i <br /> PHONIC:__ lJl ( �Zl FACSIMILE: ,9 �- d <br /> TENTATIVE"APPOINTMENT DATE: I?— 0 — Ti,,- . e �0 <br /> (Please allow 10 business days from date of application I <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCES U DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Dollarlment Use Only <br /> FILE ADDRESS UNIT <br /> 2. Slgm '2 -7 -te E- }'Ll l' .'� C1 Unit 1 <br /> 0 cl <br /> Slrtrt .CZ (�- �• I t 6ti <br /> ` p Unit 2 <br /> 20 <br /> 1111 sl'o'l 7_5I lI� & P-vp - t 6 tJCIIt 3 <br /> 81reel yG-��/J�17 �( •-din. .+ +'� Ka - le <br /> 0.\ Slrr,�1 /ter�� I A..L� tl.�� �-'4� • � 6 I � 1 `r'i� 6 j 1 unit <br /> Unit 5 <br /> ��vv p1 O�iSZ"tNAlk <br /> ENVIRONMENT L H TH DEPAR <br /> 1K UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> W OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILI'T'Y d SOLID WASTE VEHICLE <br /> 11 UNDERGROUND TANK(MON ITORINGIREMOVAL)%/ © DOG KENNEL ❑ DAIRY <br /> V HAZARDOUS WASTE GENERATOR'/ O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY✓' r%DA#— O MOTEL/HOTEL ID PUMPER TRUCKtYARDlCHEM TOILETS <br /> CI TATTOO/BODY PIERCING ❑ POOL/SPA 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 /> GONFIRMED APPOINTMENT DATE TIME <br /> DATE CON(`IPMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> elan 4842.60e <br /> s�a�zen� <br />