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T CE� S� n0N COUNTY C HEALTH t ICES <br />DSAN J . .IRQIV�PlENTAL H1r0�LTI <br />JUN 2 9 2000 04 EAST WEBER s'�oRb FLoOR <br />sro ca s . <br />ENVIRONMENT ) -3420 <br />w c -ORDS LEASE APPLICATION <br />ARPUGANT 1 p. �•.m`:'/"-f-t -C-A- � BU/SINESWAGENGY ""I (eI 1 ' C' .I e-0 <br />ADDRES:'r ?"5&5 e• lytq''-We-'5_T% , C-.O'd.-. 4 <br />hho W4 W SdOLA <br />PHONE %7 CcS�- <br />FACS1MtLE� <br />TENTAT)v& APPOINTMENT DATE TIME <br />RPreas® glome 7 to i0 busies:s days from+ date of $ppliaatlan submittal} r. �'. <br />CHECK BOX TO EXPEDITE REQUEST - F66 - PIK } SED IN a BUSIMESB DAYS <br />SIGPIATUR>= OF ApRLiCANT �cr��.�' < DATE �i•-'L`a <br />i� <br />ylJ �.a •f <br />ENVIRONMENTAL H LTH UIVISION FILE"i JUIJ <br />3 0 ^inn <br />tiddDA:RGROUND TANK {UST) CLEANUP SITE (LOP) ❑ t[OUSING ARATEMENTSOLID WASTE FACILITY <br />OTHER CLEMUP Sfi'la (Nt�t 4_Op) E3 FOOD FACILfl" Y r3 SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MQNIT4Ru+tt MaM0vAL.1 [3 000 IENNLL ❑ DAIRY <br />HAZARDOUS WASTE GENERATOR n CH H ❑ DAIRY <br />TiiEA7ME41T PLANT <br />TATTOO PERM(BOU lFED FACIi.fCY ❑ MOTE INOTEL ❑ PlifdPERTRUCWYAIiialCHElY TQ0.E7^y <br />O MEDICAL <br />WAS' PA:iRCi L ❑ POOLlSPA ❑ LAND USE APPLICATION SITES <br />>� MEAACAL WASTE FACILITY / PUBLIC WATER SYSTEM ❑ OTHgK PLEASE SPECIFY AEOVE) <br />1. List up to ion addresses in the space above, Select the type(s) of files from the list ab*vn by Checking <br />the appropriate box(es). At least one fife type MUST be selvoted. Fax to f2Q8) 4"!-0138 or mail to the <br />addrg*s Itjdigated� above. <br />2. EHD Will notify the applicant if any END files exist. An appointment for revteW Will be confitTned <br />approximately five business days but no later than ten (10) days after receipt of applicaWn. The files <br />will be field for a maximum of five business days for review. Appointments should be scheduled <br />accOr'dingly. <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 he submitted when the file is available. <br />4. Any fife not returned in the same condition as released will be reorganized by EHD staff at the expense <br />Of the A3App;lCant. Futurb file revleWs by fake same applicant may require a $i78-00 deposit prior to review. <br />$. <br />*TENTATIVE appointment Oates must be confirmed with EHD staff. <br />8 applications received after 8:00 pm will be processed the next business day, <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX <br />INMALS <br />TOTAL P.O2 <br />e <br />