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„­*27V3/2005 15:17 FAX 209 94806 ” 191002/002 <br /> cnv�...a ,,,...,.�.. <br /> Ir I U SAN JOAQtAN COUNTY <br /> ENvmomENTAL H EALTR DEPARTMENT <br /> FF9 A 9n99 304 E Weber Ave 3"'Floor Stockton, CA 95205 <br /> ENVIRONMENT HEE 1468-3420 Fax: (209)464-0138 Web:www.co.san joaquin.ca.us/ehd <br /> PES MIT/SERVICES PUBLIC RECORDS LEASEPLICA. <br /> APPLICANT:' �'^- 5��✓ _ Bt1SINF.SSIAGENGY <br /> ADDRESS: <br /> PHONE: - FACSIMILE: <br /> TENTATIV9'APPbuiTmENT DATE: IS lob Time: 12 -- <br /> (Please allow 10 b—ine-s-s days from date of application subrn(=Q <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE--REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> t Use Only <br /> FILE ADDRESS <br /> UNIT <br /> 0 <br /> a .KA me— Unit 1 <br /> �► v,5 T- z sure <br /> H su— 11120 City FEP �o U <br /> .. sums ➢yC a n <br /> l-1w S. a !f Unit 3 <br /> YsT G. S+ bq ca . <br /> ,� L6-rG a <br /> o. 34rA -F <br /> S. sues a )) (3 Unit 5 <br /> r •Ia. snt CXY <br /> • VA� <br /> -ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 9 UNDERGR6UND TANK(UST)CU6aNUP SITE(LOP) ® HOUSING ABATEMENT IRL.SOLID WASTE FACILITY <br /> 1i OTHER C1,FANUP SITE(NON-LOP) O FOOD FACILM ® SCUD WASTE VEHICLE <br /> Q� UNDERGROUND TANK(MONiTORINGIREMOVAL) ❑ OOG KENNEL &DAIRY > <br /> E3 CHICKEN RANCH 19L PKG TREATMENT'PLANT <br /> 0 }{AZAL2ll®US WASTE GENERATOR ❑ MOTEL/HOTEL PUMPERTRUCtvYAR,,CHEfit TOILETS <br /> O TIERED Pt=RMPiTE4 FAGILiTY CI POOL/SPA LAND USE APPLICATION SrrES <br /> O TATroOISODY PIERCING <br /> ❑ MEDICAL WASTE FACIL TrY d 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 EHO 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 net <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 atthe expens <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to revie' <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 /> PP't)tNTNtt^Nfi A:YFiTIMI: ���•' � ",� •0. ,.. > :derv?"ate <br /> .1 .. • 1 • . . .Jt:.�.. -••- i f�W i <br /> 'pAT>✓•CQNI•l 14Ei, ' - =''PHONE • FAX"; - <br /> >e = ' <br /> .REVIEWED -_ YES NO <br /> REV]FEW DAT E-* <br /> assn fi;. 3zde . <br />