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DATE"RECC,,1VCD FHD LOG NUMBER <br /> ��,,,.✓, SAN JOA.QUIN COUNTY __kk:NV1RONMEN1'AL HEALTH DEPARTMENT <br /> 304 C Wcbcr Avc 3"'Floor Stockton, C.A.95205 <br /> (209)468-3420 Dtx: (209) 464-0138 Web: www.co.sanjoaquin.ca. c <br /> PUBLIC RECORDS RE LEASE A,PPLTCATION <br /> APPLICANT: 4.L•O BUSINESSIAGENCY: <br /> ADDRESS: <br /> PHONE: .... _`_37127 6_ FACSIMILE: d <br /> TENTATIVE*APPOINTMENT DATE: - ( <br /> (Please allow 10 business days from date of application I <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUE=ST PROCES U DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Devarlmonl Use Only <br /> «y �y FILE ADDRESS UNIT <br /> 1. Slrrrr L-�(�''V) �,.p• ; _ cl '�7]1•'ti ISI ,1 <br /> 2. $ir rl wq -tq Gt } /�0 Unit 1 <br /> C GIIY QC7 y/ Na ,O �7 <br /> h. glr",i 2- J Y �S �O` �C7, Cil •l� 4 Unit 2 <br /> 5. SIrCrl r7',�y_+ 'e, GII <br /> Fr. Streel 4�lKl� ,e~-�p�,•'�, p Cil� <br /> 7. $Irr,�t 7-43 1 Y e�r+ D S F'—ct Cit D <br /> e. strocl 75 ;; .c g c. cn 9Rb <br /> C* P__j Cil <br /> io. sireel `� M p� cl #tJ!it5 <br /> tt, 3iolu 3 k M-�a.U. <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> !$f OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILI'T'Y O SOLID WA5TE VEHICLE <br /> 11 UNDERGROUND TANK(MONITORINGIRF MOVAL) O DOG KENNEL 0 DAIRY <br /> II HAZARDOUS WASTE.GENERATOR 0 CHICKEN RANCH ❑ PKG TRErAYMENT PLANT <br /> i� TIERED PERMn'TED FACILITY 0 MOTELIHOTEL Q PUMPER TRUCK/YARUICHEM TOILETS <br /> 0 TATTOO/BODY PIERCING L1 POOLJSPA Q LAND USE APPLICATION SITES <br /> Q MEDICAL WASTE FACILITY ❑ 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 208 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD 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 immedlately available for review. A new <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 at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates muss; be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE J, TIME <br /> DATE CONFIRMED _ PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW pATF <br /> RHA 49.152.006 •"•• "" <br /> 818200] • <br />