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SECOR PAGE 92 <br /> 07/28/2003 10:34 9168610430 FIFTH FLOOR <br /> bIILj1'edU'3 15:15_ 20g' 13433 <br /> i L-rl[iLu�NJhSlikk ] <br /> 3AitS(kGrN1 D SAN J_0AQi U!N 'COUNTYPU8b HEALTH SERVICES f <br /> ! l; ENVIRONMENTAL KEALTH DIVISION <br /> 304 BAST WEBER AVENUE,•TKIRL)FLOOR <br /> ' STQI;,KTC]N CA 85202 <br /> 1 <br /> j)�_ Z003 (209)468-3420 <br /> PUBLIC RECORDS RF-LEASE APPLICATION <br /> 'I!'i�-i'd 15'.!...14 f ! I,_.t � .. .' �V• . <br /> APPLI�AIit" '' <br /> -^ Ilii13 BUSlNE5S1AGENCY <br /> ADDRS,= DI �Gt <br /> lx+ ACSIMILE �j <br /> PkiONE <br /> 7ENTATIVE'APPOINTMENT DATE u <br /> TIe oe give T to 10 bua) S clays from ate of appliaaugn submltol) <br /> j <br /> CHECK DOX TO EXFE41TE RE EST-587.00 FEE—REQUEST PROCESS"IH 3 BUSINESS DAYS I <br /> DATE 0`7 •24• D <br /> SIGNATURSOF APPL]CAN-T .. <br /> I <br /> ' k <br /> 9@ <br /> FILE ADDItE55. THIS SIDE D STAFF!J0lttl�Y <br /> PROGRAM ELEIV EN79 ARCH <br /> 3tk r d�:n. `T•raG GA qS3 5 <br /> 2 3 5 Ta she 10' i <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 'f ■ UNDERGROUND TANK(U371 CLEANUP SITe[L.OPi'❑ 11oUSING ABATEMENT 0 SOLIC3 SOLID WAZTE WASTE FVEHLCLE <br /> ACILITY <br /> OTHER CL AIdUr SrrE(NON-LQP) . f[ �•Ap�L)* a F400,>'ACtLl7Y ❑ DAM <br /> ❑ UNDE6RGROUNPTANK(E4MOMrrQRINGfR1^MGYALi 0 CHI K-:N RA ❑ PKC TREATMENT PLANT <br /> ' ❑ 'HAZAR.DOUS VVA.ST9 GENERATOR' ❑ CHICKEN RANCH 13 PUIVMPE4tTRUCKIYAKD1aHEMTOII11TS <br /> E3 -[MRFD pSRMITTW FACILITY 0 M7ML1KQTEL ,❑ LANA USE APPLICATION SITES <br /> ! Q TaTTOoJtOFIY INSIRCING0'POOi15PA IC 4TU"(pLEASP SPECIFY ABOVE) <br /> E3MF_UICAL WASTE FACILITY 10 PUBLIC WAT£RSY9TI;N <br /> 1, List up to ton addresses in the space ;Jbave. Select the types)of files from the list abate by checking <br /> the appropriate dies a t le at one file type MUST be selected. Fax to(20914M-0131-0►rnaiLtlo the <br /> box(} addre j Ica a ove <br /> 2. exist. An appointment for review will be colon. <br /> med <br /> EHD will notify the applicant if any EHO files <br /> approximately five business days but no later than ten(10)bays after receip#of applicationThe COX <br /> will be held for a maximum of five.tausiness days for review. Appointments should be scheduled <br /> accordingly, <br /> 3. A file that is actively being worked on by EHD staff may notice ImmediatIely avallahie for!mvievr. Anew <br /> application may be stibrAitted whon the fill is available, 1 <br /> ed by EHD staff at the expense <br /> 4. Any file riot returned in the same condltlari as released will be rearganizi <br /> of the applicant. Future file reviews by the same*cppl=nt may require a$13T,00 deposit prior to review. 3 <br /> S. *TENTATIVE'appointment dates must be cbnfirmed with EHD staff, <br /> �. <br /> Applioations,received after-3:00 pm will de.processed the next buslness day <br /> CONFIRMED APPOINTMENT'DATE TIME <br /> l7ATE CONFIRMED _ _-- - PHONE , FAX INMLS <br /> REVIEWED YES NO REVIEW DATE <br /> t , <br />