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01/:0/2006 09:49 FAX 1 209 234 STOCKTON 149002 <br /> 01/10/2006 09:34 464013 ?72? ENVIRONMENTAL H PAGE 01 <br /> L+q� IVCIJ crly w�ivurvtocrt <br /> SAN JOA,QUI[N COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, V1 Floor,Stookton,CA.95202-2708 <br /> `l.Lv'fktephone:(209)468 3420 Fax: (209)464-0138 Web:www.sjgov.org/ebd <br /> 11� -N VBLIC RECORDS S LEASE APPLICATION <br /> APPLIC I Gk �5 BUSINF•SSIAGENCY: a�� u 0 �'A <br /> ADDRESS: 34 IQ W.l-�ar�.w«r t �wttr �u��e,F_ cA1Y 5T11-V66 sTATF--CA <br /> PHONE(l)., 23r{-7 2z PHONE tai: FACSIMILE: 231-7 7 2' <br /> TENTATIM APPOtNTmm DATE: rye: <br /> (Places allow 10 business days from dabs of awcatinn submidw-wr only-must be <br /> CHECK BOX TO EXPEDnE REQ =- <br /> El;;;;n—f;", 0 <br /> H OR CHECK ONLY)-REQUEST PROCESSFA 1 i3 <br /> SIGNATURE OF APPLICANT L`~----- DATE i�I�� <br /> d Llot Map-Deoaripttork <br /> rm <br /> Infoation <br /> FiLE ADDRESS EHD USE ONLY <br /> street 9 Street Name CIW <br /> .1. 0 -Jnit 1 <br /> 2. oo Allu <br /> 3. ❑ unit 2 3 <br /> 6. Untt 4 <br /> 7. <br /> S. Unit 5 <br /> 9. <br /> 1®< Unit 6 <br /> Specific Date Range of information Requested:From to <br /> ENNqRONMENTAL HEALTH DEPARTMENT PILES <br /> 1p U140MMUM TANK(UST)CLEANUP SM(LOP) At HOU8M16 AeATiNAIINT RSoup <br /> WASTE TIRs FAr� nYivEI41CLE <br /> V OTHER CuANUP ins(Non-LOP) 0 FOOD FACILI Y <br /> ®DOD KENNEL A DAIRY <br /> ffi.UNDtaRDOW W TANK 111119 ATOR ciRrMOYAL) Q cmcKsN RANcN M wASTMATERTREATInEEdT PLANT <br /> {3l HAEARDOUS wAsre GeN>:RATc� <br /> T&TiERED PEFMU TED FACILITY 0 MOTELiHOTEL ❑PUMPERTRUCWYARDICHEMALTOII,ETS <br /> TATTOOMODY P IEROM ❑POOLISPA OTHER( i�ND USE APPLICATION SITES <br /> 1�LMEDICAL W ASTE FACILITY ❑ pLEAsa SPEtY) n►. I <br /> WELL Alto SEPTIC PERMrr Recome ARE AVAI AKE FOR Rmew.TAONGAY-FRIDAY$:00 :00PM - E=LUMNO HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the fist above by checking the <br /> appropriate box(es). At lest one file type MUST be selected. Fax to(208)464-0138 or mail to the address <br /> i icate�,atMe. Address ranges}wilt not be accepted for additional assistance with file addresses,contact <br /> the EHD.Applications received after 31.00 pm will be processed the next business day. <br /> 2, The EHD will notify the applicant H any EHD files exist. An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is ac=tively being worked on by EHD staff may not be immediately available for review. Anew <br /> application may be submitted when the file is available, <br /> 4, <br /> applifile not mtumed cant t Future file tn the reviiews by the same appcondition as licleased ant mayiil be requirea$93.00 deposit anized �rr toff tthe revi wpt3ttse of the <br /> PP <br /> CHO <br /> 9A/SS/gGo6 <br />