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09/06/2005 09:37 2093694228 NEIL ANDERSON ENVIRO PAGE 03/03 <br /> EHO LOG NUM5ER <br /> DATE RECEIVE • SAN JOA.QUIN COUNTY <br /> RF'(CEW EDOEN' VTRONMENTAL H Ai H �FPARTMENT <br /> 304 E Weber Ave 3 Fl.aor Stockton, CA 95205 <br /> Sy NON) 468-3420 Fax: (209)464-0138 Web, www.co.sanjoaquin.ca.us/ehd 177 <br /> F�l`JIROPIrI�E��� N�ALj�I - <br /> PUBLIC RECORDS RE LEASE APPLICATION <br /> APPLICANT: (� ( BUSINESS/AGENCY: <br /> ADDRESS:_ 1cc)� <br /> PHONE:_240 l —FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: cK� 20 Time: �� 00 <br /> (Please allow 10 business days from date of application submittal) <br /> ED CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINE85 DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> 1 Department Use OnlY <br /> 11 FILE ADDRESS UNIT <br /> ,. sueel Jrl S, ►1 ell - okC v-CO1k IUnit❑ Unit 1 <br /> 2. street ►� IbD <br /> � S 1 II CI OI.( tI!vlY C��1 S SPO Yx <br /> y1 W 1 Cu rn �/� Ye�.� `(t �iIPO Unit 2 �a�S <br /> �. Slrvrt V GI r'7 C • 1I e Y Yk. 1 I - leo V' <br /> /Unit 3 �1i5 <br /> 6. Street oty. I <br /> T SIP, clly Unit 4 <br /> n s,reel r..ny _ <br /> P sly, My ❑ Unit 5 <br /> Ci <br /> 10 Street <br /> -/ ENVIRONMENTAL HEALTH DEPARTMENT PILES <br /> rl UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 11 SOLID WASTE FACILITY <br /> td OTHER CLEANUP SITE(NON-LOP) 4 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> 11K/UNDERGROUND TANK(MONITORING/REMOVAL) C3 DOG KENNEL O DAIRY <br /> AZ.ARDOUS WASTE GENERATOR D CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY a MOTELIHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOO/BODY PIERCING O POOUSPA D LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-013$ or mail to the <br /> address indicated above. <br /> 2. END 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EMDpe.oZ-0aG <br /> 8!8/2009 <br />