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10/14/2004 17:20 209467,1& AGE STOCKTON PAGE 01/0 <br /> EHD LOG NUMBER <br /> DATE RECEIVED.. <br /> C <br /> SAN JOAQUIN OLIN <br /> ENVIRONMENTAL RFALTH DEPAR NT <br /> (� 4 304 E Weber Ave 3`d Floor Stockton, CA 95205 Z070 <br /> 7( 0 4 468-3420 Fax: (209) 464-0138 Web: www.co.san joaquin.cams/ehd <br /> �lEF11 'riE�l_iH <br /> - PUBLIC RECORDS ULEASE APPLICATION <br /> APPLICANT: dIIQ RUSINESSIAGENCY:/jQdy,LnC,0A <br /> ADDRESS: t� �ryS u) <br /> PHONE: 7 ! —/0,0& FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: gl lod• 4�/O� Thm. <br /> (Please allow 10 business days from data of applirstlon submittal) <br /> CHECK BOX TO EXPEDITE REQU .00 FEE-REQUE T P OCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE �� I <br /> Department Use Only <br /> FILE ADDRESS UNIT ` <br /> �. street <br /> t ❑ Unit 1 <br /> 2. sfmd 1 t y 1Cry <br /> a anet a;? [ Cry ffj d n ❑ Unit 2 <br /> ,. Street Q 3 . 1 MOL - - 0,0 <br /> c 'J Unit 3 <br /> 7. 5t1e+ Unit 4 <br /> 0. srmwt <br /> COY <br /> s. srea< ❑ Unit 5 <br /> 10. Strout <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE=S <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) Cl DOG KENNEL ❑ DAIRY <br /> VIC HAZARDOUS WASTE GENERATOR O CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKNARD/CHEM TOILETS <br /> d TATTOOIBODY PIERCING d POOLISPA ❑ LAND USE APPLICATION SITE$ <br /> 0 MEDICAL WASTE FACILITY to 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(2091 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 immediately 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 END 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 must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMW APPOINTMENT:0ATi; . :.'WE:: :. <br /> bATE C40NFtR'MtD _ PHDNE: 1=b�7C ENii'(ALS`:::: _ <br /> REVI�VNE>, :: :YES N'O.. -. !~V(EW flAT`E <br /> EHD 48-02-008 <br /> 4!!l200a <br />