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09/16/2005 13:30 209472q& PAGE 02/02 <br /> =W11MID <br /> 4640138 EAIVIROWENTAL HEAL4 PAGE 02 <br /> SAN JOAQUIN COUNTYPU13LIC HEALTH SERVICES N <br /> P 6 2005 ENVIRONMENTAL HEALTH DIVISION , ov <br /> 304 EAST ivR AVENUE,THIRD FLOOR <br /> ENVSRMMI[NT iiEALTH STOCKTON CA952Q2 <br /> PERF:" T,�UERVIGES (209)468.3420 <br /> PUBLIC RECORDS LEASE APPLICATION <br /> aPwatTcANT PUS114M OMeY®�V- �,-- SYS W z <br /> ADDt�ss �o�v- _ <br /> PloNE FAMMILE <br /> TENTATW APPOfM ANT DATE TllYit: . <br /> (Pleasts*Nt 7 to 10 twsttaw&A from dale of am ftatiim submlital) <br /> cHt cit BbX TO ac QU <br /> R@E3 F. 89.04 — l QK 313 N Y — <br /> SIGNATURS OF APPLICANT pA <br /> FILE ADWS THIS smig 8Hp STAFF USE My <br /> PMMRAM ELIUAENTS SEARCH <br /> 77 6 <br /> ENNtRONMEmTAL HEALTH DIVISION FILES . <br /> VNOERGROVND TANK PSI)CLEANUP SITE(LOP) Q H=We ABATEMENT Ll SOLID WASTE FACiLITY <br /> R CLEANUP SITE(�lW'1d.OP) Q FOOD F ® SOt rt�WASTE VEHICL.t <br /> VNDERGROt1ND TANK aptONITOIiiftGl[ZEW10VAL) Ct WO KENNEL. G DAIRY <br /> CI AZARDOUS WASTE GElISRATOR ❑ CHICKEN a PKG TREATMEMT PLANT <br /> 3 '(tERED PEtiNrtTgD FACIU7Y D MOTMitlOTEL ❑ PVMPER TRUCKfYARDICHe d YOWS <br /> ❑ TA PE ❑ POONA D T,ANO tJ8£APpLtCATTQN STYES <br /> T3 M WASTE FAOtt,iT1► la PUBLIC WATER SYSTEM 13 amp-R( S SPECIFY ABOVE) <br /> 4. List up to tett addresses in lire sAwe above. Sept the type(s)of files from a list above by checking <br /> the appropriate box(e!* At least one file We MUST be selected. Fax to 24 4t;4-x138 or analt to the <br /> S5' atfbve ' <br /> Z. EHD will notify the applicant if any EHD files exist. An appointment for revl®W will be confirmed <br /> appr"imately five btiklness days but Tw tater than ten('i 0)days after receipt o a d be t4fie The files <br /> will be held for a maximum of fire business days for review. AAPQintTttents should be scheduled <br /> accordingly, <br /> 3. A file that!--actM4lr belxtg worker an by t"t40 staff may not by immediately available for reViBYV. Anew <br /> applicatton rrtey he submitted when the file i$evaitsbte't 1514D staff at fife expense <br /> 4. Any file noreturned in the Ttarne condition as relewsdd will be racrgOnized by <br /> of the a note return <br /> Futuro file reviews try the same applicant may require a$89.00 deposit prior to revieW. <br /> g, *TENTATIVE ApPQintttient datN must be confirmed whit END staff. <br /> �. Applications rece'iv'ed after 31:00 pm will be Mcessed the next business day. <br /> CONFIRMED APPOINTMENT VATF.- TM I. <br /> DATE CONFIRMED PHONE FAX 1NMALS <br /> REVIEWED YEs NO REVIEW DAr'E <br />