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SECOR PAGE 01/01 , <br /> U ij t ii y <br /> 07/28/2003 10: 34 916861043093433 FIFTH FLOOR PAGE 02 I <br /> ee.i '15:15 20' <br /> JAIk KtGEPIt:D GrIU W�NJSEU�:}c <br /> SAN JOAQUIN COUNTYPUELIC HEALTH SERVICES 1 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKrON CA 95202 q0 <br /> 8 r 003 (209)468-3420 <br /> PUBLIC RECORDS RF-LEASE APPLICATION <br /> ;.�-moi ..__ TVIn1 BUSINESS/AGENCY_ <br /> APPLILANY'' L <br /> ADDRESS G� 1\ (� �kxI C <br /> ( L `� a�O� � <br /> PHONEnLv1�[��Qa lJG�•� AC5lMILE r <br /> �� ir9) C� C]��O <br /> 3 <br /> - J <br /> TENTATIVE*APPOINTMENT DATE Q V 5� Zo-s TimC -Pl� ao(Please give 7 to 10 bull ss days from ate of appllaation submlttal) <br /> CHECK BOX TO EXPEDITE RE EST•387.00 FEE-REQUEBT PROCESSED IN 3 BUSINESS DAYSSIGNATURI:DF APPLICANT ��A,�� L� ,�_-. DAVE O`I ' (o 1 <br /> FILE ADDRESS THIS SWE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS WROH <br /> 3(G r Li.. �. `I—raG C-A 9 S3 � 3 5� 1 <br /> 2 3 5 To sheo <br /> l� <br /> LUO <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ■ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Cl HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> N OTHER CLEANUP SITE(NON-LOP) -_T�—AR-.O*- ❑ F000 FACiLrrY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUNPTANK(MONITORINGfREMpVAL) O POG KENNEL ❑ DAIRY <br /> ❑ CHICKEN RANCH ❑ PKC TREATMENT PLANT <br /> I❑ TIERED'HAzARER WAETl_GENERATOR Q PUMPER TRUCKrYARDICHEM TOILP-79 <br /> ❑ TIERED PERMITTER FACILSTY l7 MQTEUHQTEL <br /> CI TATTOCIBODY PEIRCING ❑ POOLISPA ' Q LAND Use APPLlCATK)N SITES <br /> ❑ MEUICAL WASTE FACILITY Q PUBLIC WAT-5R SYSTEM b OTHBR(PLEASE 9PP.CSFY ABOVE) <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 boxes), At least one file type MUST be selected. Fax to(209)464-0130 or mail to the <br /> address indicat®�bove, <br /> 2. END will notify the applicant if any EHD flies 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 immediataly available for roview. A new <br /> application may be submitted when the fila is available, <br /> 4. Any file not returned in the Same condltion as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant maty require a$37.00 dnposlt prior to review. I <br /> 5. RTENTATIVE appointment dates must be confirmed with EHD staff, <br /> 6. Applications received after 3:00 pM will be processed the next business day. <br /> FrC,ONFIZEDAPPOINTMENT DATE TIME <br /> GATE CONFIRMED _ PHONE . FAX INITIAL$ <br /> REVIEWED YES NQ REVIEW DATE I <br /> CH o0 14 QMM <br /> I <br /> I <br /> I <br />