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-X9/21/2004'."1-4`22 "925283E AFT CONSULTANTS' `) . PAGE 01 <br /> 01/03/2003 15:16 4640139 ENVIRONMENTAL HEt-.i PACE e2 <br /> u i is a I0J SAN JOAQUIN COU"UBLIC HEALTH SERVICES <br /> r ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEER ON CAE THIRD FLOpR RioS F P 2 1 2004 sroci<roN CA 95202 <br /> (209)468-7420 3 <br /> ---�ENVw,j vivltld I HEALTH, PUBLIC RECORDS RF-LEASE APPLICATION <br /> APPLICANT 1 S Ot DUSINESSIAGENCY <br /> AODRESS 2500 Cnvvr„nv QiIA�O C✓ tv i� q 45a�7 <br /> PHONE_ 't2-5 2va :3 —Co 00 U PAcsiMH-r 0125 '2-93— C9 (?=A . <br /> TEN7ATIVE0APPOINTktENT DATE TIME <br /> (Please plvo T to 7e busloass days from date of apnnoaUon svbmlltal) <br /> CHECK 60X 70 ExPEDITE EOVEST- .ee �ZQVIEST PROCESSED IN]BUSINESS DAYS <br /> 'SIGNATURE OF APPLICA DATE V yl n <br /> FILE ADDRESS THIS SIDE END STAFF USC ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> -we LU6- ;. <br /> N,.rkfl CIO <br /> 4 1-1 V\Lg- v < �,t if-z., 4 <br /> 290 west-L-a .cu`�j,�+Z tiE5 1�i a153 ✓ <br /> BIZ C4 P�vIw1 W I T.r L -- ✓ <br /> 15 zS ;..Mai 5 l O <br /> 33 }. q h If ES <br /> ENVIRONMENTAL HEALTH DIVISION FILE$ <br /> UNDERCRouiln TANK(V5T'1 CLEANUP SITE(LOP) 0 Hour LNG AOATEMENT 0-SOLID WASTE FAYY <br /> OTHER CLEANUP SITE(NON�OP) 0 0 I)FOOD FACILITY SOLWASTE VE}T L n <br /> UNDERGROV)IC TANK{MONfTORINGIREMOVAL) 13 DOG KENNEL 0 DAIRY. ��' <br /> .. tfAZARO0U5 SVASTE GENERATOR 0 CHIMEN RANCH 0 PKG TREATMENT PLANT <br /> JR <br /> T1EREb PSReArrrEO FAC7LnY 0 MOTEIOTEL 0 PDMPER TRUCHhfARetCHEM TOILETS <br /> tl TATTOOl000Y PEtRCING '0 POOUSPA 0 LAND VSC APPLICATION SITES <br /> MEDICAL WASTE FACILITY , 0 OTHER(PLEASE SPECIFY ABOVE) 1 <br /> 1, List up to ton addresses In the space above. Select the type(s)of files from the list above by chocklnn <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 1209)464-0178 or mail to the <br /> addressindic�atcd above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for rdvlow will be confirmed <br /> approximately five business days but no later than tan (10)days after roceipt,of application. The riles <br /> • will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> O. A file Ihat;Is,actively bbing worked an by EHO staff may not be immediately available for review. A nex <br /> apptic tion may be submitted when the fila is available. <br /> 4. Any fire not returned in the Same condition as released will be reorganized by EHD staff at the expenst <br /> of the applicant. Future file reviews by the same applicant may require a $89.00 deposit,prior to revlcv <br /> 5_ 'TENTATM 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 CONFIPMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE ^'� <br />