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1; NAN J OAQUIN UOUNTY <br /> ENIMONMENTAL HEALTH DEPART <br /> 3 eber Ave 3`1 Floor Stockton,APR 1 5 200 on,CA 95 �� <br /> 209)468-3420 Fax: (209)464-0138 Web:www.co.sanjoaquin.ca,us/ehd <br /> {d ' iii_ �'. -i4 ' or-A H <br /> 1 rES PUBLIC RECO S LEASE APPLICATION <br /> APP WE L4,-4 L S. S Elf 1-Ro i✓ BUSINESSIAGENCY. <br /> ADDRESS: Pe,-Z/_/ ZR®ULi9 4, -y TR1g CJ q $3 7 <br /> PHONE: 1�Qr (-1 S 6— 1-16® FACSIMILE: �4o`f' A'3 o• 75-910 <br /> TENTATIVE;APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> (NECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OFAPPUcANT DATE 14-1S-diJ <br /> Department use Only <br /> FILE ADDRESS UNIT <br /> ,. saes 18S Lv Co 1>M <1 v� S Tae�eTo y q S�o y <br /> s. S"dl t�T v �► �' Unit l <br /> 3. Street <br /> s. sweet ❑ Unit 2 <br /> S. SSuedd1 <br /> s. un3 <br /> Or- <br /> it <br /> 7. Street 10 t-uu-r <br /> 1d. shed Unit 4 <br /> 9. sheet <br /> - 10. Sbvd ❑ Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ® UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ® OTHER CLEANUP SITE(NON-LOP) ®I FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 12 UNDERGROUND TANK(MONIToRINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> US WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> R TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOBODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL.WASTE FACILITY ❑ OTHER(PLEASE SPEC. <br /> • 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(209)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 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 must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> :; OIVF1,RMfD APPoiNTMENTnATE -.. <br /> TIME h <br /> DATE CQNFIRMED - <br /> PHONE FAX INITIALS .:# <br /> atEVIEWED -YES NO REVIEW DATE' <br /> " EH048-02-006 : <br /> t118t2001 <br />