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;-S-iZ 2?00 10:2eAM FROMI` TO .15592Ca712G P.02 <br /> k1W LIH:Mi]MpILk <br /> r <br /> L 11 �D <br /> SAN JOAQUIN COUNTYPUBLIC 14EALTH SERV CCS <br /> �E� ENVIRONMENTAL. HEALTH:DIVISION <br /> 304 EAST WEIBER AVENIJE,THIRD FLOOR <br /> OCT 7 2000 $TOCKTON CA 95202 <br /> I� (209)463-34a <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RF-LEASE APPLICATiON <br /> "PERTPc�Nr r7 � BUSIN,ESSIAGEI�iCY <br /> fW DRESs <br /> 'j <br /> TENTATIVE*APPbruwFtiT DATE TIME <br /> (Pluase;lva r to 10 bu5Ino=days from date of appllcaftn subcnitlsl) <br /> CHECK BOX TO EXPI2017E REQUEST-$a7-OU FEE— VEST PR00S2S20 IN$BUSINESS DAYS <br /> SIGNATURE DF APPLICAK-r GATE <br /> I� <br /> FILL AADRI:SS Wa SIDE 9HO STAFF E ORLY I <br /> PP.aGRM EtMEHrs sEA=H <br /> C <br /> :I <br /> ENVIRONMENTAL HEALTH DIVI610H FILES <br /> ji VNDERGROUND TANK(UST)CLEANUP WE(LApj CI KGU$WGA13ATI34XT Q 601-0 WASTE FACILITY <br /> IIERCLEANUP SITE(NOMLOP) O FOODFACUTY Q S0t,ti?WA5TEVEMCI.E <br /> ;UNDERGROUND 7AffK(MUNITOWNGIREMOVAL) 0 BGG t(ENNEL n -IOAIRY Y <br /> II }igLAFii3Oii5 WAS7Y GEN:=KA14R 0 CHICKEN UNCH 0 PKG FRtATW-NTPLAXT <br /> d TIERED PERM=ED FACILITY 0 NCAEUHOTEL Q pVi11pERTRUOKIYhRt3dGtlElA 741t>ETs <br /> " C TATT001BODY PPJFc0ING Gl PQoUsPA ❑ LAND U-SE APPLICATION5"ES <br /> G MF-DiGAL WASTE FAC LIT C1 PUBLIC 1MATER MTEGd C] OTHER(F+L ASE SPECIFY ABOVE) <br /> 7, U:St up to tett addresses in the space above. •SDIea the bW(s)of f0eg frofn the H5t.ebQVB by ChCRkiRg <br /> the appropriate box(es). At least ona file"MUST be selected_ Fg tea MOP)940138 or[rlArilto the a <br /> .6 - j�dS1J'LSS)Tld,{C$#�tl �1bOV�. <br /> :I 2. EHC will notify the applicant if any EHO fibs exlsL An apppintriterd for reView Will tea Gonflnn0d <br /> E approximately ftva bUZiness days trot no later th&n ten{10?days after mccipt of application.-The files <br /> vrili be held for a ma7jmum of flye business stay$for review. Appointmonts should be sclreduiod <br /> acsnrdirl0(y. <br /> 3. A file that Is argiYely being worked on by EHI]staff(nay not be immediately available for r41ri@w. Anew <br /> application may tie,submitted when the ttie W availablc. <br /> 4. Any file not rstUrned In the Sante condition as raioasod will be roorganize d by END 3W at the expanse <br /> of the applicant Fukure file revltws by the same applicant may require a$87.40 deposit prior to review. <br /> a. *TENTATIVE appointment dates must bo confiff Rd With EHD staff. <br /> 6. Applications received after 3:00 prn will tie procassed the next business day. <br /> i <br /> �ONFIRIIAED APPoinmExT DATE TIME <br /> PATF-CONFIRMED _ PHONE FAX INITIALS <br /> ` I . <br /> V1sWED YES NO REVIEW DATE <br /> Et va�s 1°4 <br /> TOTAL P.02 <br /> E <br /> .I <br /> �I" <br />