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/` v a <br /> SAN IOAQUIN COUNTYPUBUC Hl=-ALiN 7-RVICES IL;',l <br /> L7 J ENVIRONAI ENTAL HEALTH DIV .4 <br /> �J S 304 EAST WEBER AVENUE,THIRD FLOOR <br /> �I STOCKTON CA 95202 �� �A <br /> l (209)468-3420 <br /> PUBLIC RECORDS RE-LEASE APPLICATION <br /> \ APPL1 IY .�ElU3fNESS/AG1=MCy��Lt•i.>� ,���rJY't�r /ft�- - �I �"I _ll <br /> A KESS-937 tXd - <br /> HONE d „L(L+r rW )ACS1MILi MY <br /> TENTATIVE*APPOINTMENT DATE TIM>; <br /> •Irl. ,iv tl r ��1LIH <br /> (Please UjW 7 to 1D business days irom date of appGCatlon zubmkta[ <br /> 1 r FS <br /> -l�v.rs 3. jarclr <br /> *CHECK SOX TO FJCpED17t;REQU � <br /> -578.00 FEE-t�EQ�STt�GESS�,NUSINE5�11 S �s <br /> SIGNATURE OF APPLICANT DATE a <br /> FILE ADDRESS <br /> d in aye oo - <br /> py- <br /> �� n �� <br /> j1W <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q HOUSING ABATEMENT Q SOLID WASTE FACILITY <br /> OTHER CLEANUP 51TE{NON-LOP) 0 FOOD FACILITY Q <br /> UNDERGROUND TANK(MONITORINGIREMOVA1 SOLID WASTE V>=tIlG� <br /> HAZARDOUS WASTE GENERATOR ) O DOG KENNEL D DAIRY <br /> Q TIERED PERMITTED FACILITY Q Cii1CKEN RANCH Q PKC•+TREATMENT PLANT <br /> 0 TATTOOMODY PEiRCING Q MOTEL/HOTEL 0 PUMPEit TPuCKlYARDJCkjr=M TOILETS <br /> MEDICAL WASTE FACILITY d POOLlSPA Q LAND USE APPLICATIONn� <br /> SS <br /> II PUBLIC WATER SYSTEM IJ OTHER(PLEASE SPECIFY ABOVE) <br /> 1• t.lst up to ten addresses in the space above. Select the types)of files from the list above by checking <br /> the appropriate box(es). At feast one file type MUST be selecteid. <br /> address•indicated above Fax to (20$)464-0138 or matl to the <br /> 2• EHD wilt 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)clays after receipt of application. The files <br /> Will be held for a MaximuM of five busyness 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 /> d• Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant, Puture•file reviews by the same applicant may requia $78.00 deposit prior to review. <br /> 5• 'TENTATIVE appointment dates must be confirmed with EH[]staff. re <br /> 6• Applications received after 3,00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CCNFIRMED PHONE FAX INITIALS <br /> REVIEWED Y(r5 NO <br /> EH REVIEW DATE —___.... <br /> oa t7 otrostio <br />