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--e2/14/220001 17:36 2093694 IFIL ANDERSON RAWO PAGE 02/0 <br /> �+7 5 D EHD i3OG NU :R <br /> SAN JOAQUIN COUNTY <br /> 701 i 1� EN Y AR®N1YlfOA A'AR./HEALTH DEPARTMENT <br /> 304 B Weber Ave 3r`'Floor Stockton, CA 95205 '� 0mom am&10" 11 <br /> EPWIRONMENl HK26 M468-3420 Fax: (209)464-013$Web: www•co.sanjoaquin.ca.us/chd <br /> PERMITISEIIVIGES 5 <br /> PUBLIC RECORDS RE LEASE APPLICATION <br /> APPLICANT: --^RC-C-C> BUSINESSIAGI NCY: RA <br /> ADDRESS: f 0-2- <br /> PHONE: �J�R� - l FACSIMILE: 3(aeI <br /> TENTATIVE*APPOINTMENT DATE: 3 10 1 1 <br /> _� <br /> (Pisase allow 10 business days from date application submittal) 2®®� <br /> CHECK BOX TO EXPEDITE REQUEST-19,100 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> \ ' I, Street �SK <br /> 2+5 S• b Y^C city <br /> 2. .street 1340 W � W&j�W S�. CII . [I Unit 1 <br /> a. Slrcet cit [j Unit 2 <br /> 4. Sired Cit <br /> S. Street Unit 3 <br /> 6. Street <br /> /0_ <br /> V. Sir", G l.)nit 4 <br /> G. Street CI <br /> 9. SIMM Cit ❑ Unit 5 /- <br /> to, Street Ci <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT © SOLID WASTE FACILITY <br /> '$i. OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑ SOLiD WASTiE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ® DOG KENNEL 13 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK7YARD/CHEM TOILE <br /> to <br /> ❑ TATTOOBODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY a 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 check! <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464.-0138 or mail to th <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 file <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 n <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 expen <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to revil <br /> S. *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 CONFIRMED PHONE FAX iNIT(ALS <br /> REVIEWED YES No REVIEW DATE <br /> EHO 411-02,40t4 <br /> 819f2007 <br />