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N <br /> t Aww� <br /> �T BY:. GF,QhQG rINCZi; 4W 415 597 7880; JUN-11 -0' 1*M; PAGE I /! <br /> fel <br /> -4640138 ENVIRONMENTAL HF-ALTi-i PAGE 01 <br /> 06/10/2f!16�" 713�_.'_514"'l i <br /> DATE R&CrJVM <br /> JUN 1 1 2003 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> AVIRONMEN1 flEALI 14 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCK170N CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RE:LEASE APPLICATION <br /> iAPPLICANT � /�I- KIA IV67?—A .5USIMMIAGENCY_ <br /> ADDRESS <br /> PHONE FACSIMILE <br /> TENTATIVE*APPONMENT DATE TIME <br /> (Pleat give 7 to 110 buslne33 dayii from d9m of applICRUOn stibmittill) <br /> *13CHECK BOX TO EXPEDITE REQUEST.$89.00 FEE-RUQUEST 11ROCE33ED IN 3 BUSINES1.5,DAyii <br /> ,-SIGNATURE OF APPLICANT W%TE <br /> 515if9C' S­T,4:F USS ON <br /> FILE ADDRESS PROGRAM ELEMEP.ffri <br /> WFs;r L6NFE2TD m_ <br /> - <br /> t7 c e7 7-0 <br /> I Boo CALff0MjA 97. N. _312_0`TV N <br /> WZCIr <br /> LANAI EN -ALTH DIVI$ION FILF_'133 Joh <br /> P?',96 N- WILY®N Wjl� �"MEDITAL HI: <br /> IX UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E3 HOUSING ABATEMENT Vg <br /> j1jA'AST* FACILITY 3$ <br /> Or OTHER CLEANUP SITE(MM-LOP) 0 FOOD FA'ILITY <br /> UNDERGROUND TANK(MONITMINUMIMAL) 13 DO(;KENNEL PKG TRIZATM ENT PLANT <br /> Pq HAZARDOUS WASTE GENERATOR CHICKEN RANCH _Kjy#jtD1CIiI M TOILL-M <br /> QF TiEfffD PEPJNMD FACILITY M01711HOTEL 5t P1.1101111if"TRII,, <br /> 0 TATTOOIBODY PEIRCING E3 POO ISP k 6E LAmo WIT AP PLICATIONS TF.S <br /> MEDICAL WASTE PACILffY 0 011iERV1LEASESPEC1FY)1. __ <br /> Uit up to ton addresses in the space above. #,,;elect tho type($)of fills fr4)m the I istabuys 121Y checking <br /> the appropricktg box(es). At least one file type MUST ba selected. t-AA- <br /> addreslIndicilk2d ghave" filese-dat. An appointment for rsreiOW vi ill Do carif ii med <br /> 2. EHD will notify the applicant if any EHO nppliCatlon, The fiI96 <br /> approximately five business days but no later than ten(10)days after reCOI;It Of <br /> will be held for a maximum or five business dLys for review. AppoiniMsirttSchaiildbosChedUI410 <br /> accordingly. <br /> 3. A file that In actively being worked on by EHD staff may not be ImmedialWy Oval iilblle for ra lew. A now <br /> application may be submitted when the file Is-xvifflable. <br /> 4. Any file not returned in the same condition as released will be reorganized uy EI ID stiff at 9explinse <br /> of the applicant. Future file reviews by the same applicant may require a$a 1 9.0*delwalt p�r to review. <br /> 5. -TENTATIVE appointment dates must ba confirmed with EHD staff. <br /> Applications received after 3:00 pm will be processed th*next business daYe. . L <br /> Post4r Fax Note j'1371 <br /> CGNFqRMED APPOINTMENT GATE <br /> .a, <br /> DATE CONFIRMED <br /> R04 4 fat <br /> REVIEWED - YES NO <br /> Jai <br /> 40 <br />