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I��(�(�� ( 7 i�l�qnfl SAN JOAQUIN COUNTY <br /> �.r EHD LOG NUMBER <br /> W <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ou ( 3 0 2008 600 East Main Street, Stockton, CA 95202-30292 <br /> 1 <br /> Telephone: (209)468-342e Paxt(209)454-0138 Web; www sjgov.org/e <br /> ENVIRONMENT <br /> HEAL PUBLIC RECORDS RELEASE 1 II! <br /> LEASE APPLICATION <br /> APPLICANT: DU3INESSIAGENCY: <br /> ADDRESS: Clty/StatVrZlP <br /> PHONE(1): SS¢—:�+f•�—,fr�S�.. PHONE(2); FACSIMILE: n2�-21��/$' <br /> TENTATIVE*APPOINTMENT DATE: II U dA-;v <br /> Time: <br /> (Please allow 70 business days from pate of appGc tion submittal-'Tentat(ve only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST- E(CASH CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 0 3O <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street A Street Name City <br /> 1 0 Unit <br /> -20AV 0 yi 1 <br /> 2. rt R n R It It 5 Lf S,No / ❑ Unk2 <br /> 3. It « ft h It rt t 5 �P <br /> 4. rc e n n 11 u <br /> oa ,AEs vo cam <br /> a,6M 7J33 it G n u n 11 4e_(o L) �,6FS, vo ca✓�� unh4 <br /> 7• d It I( rt D u nIle <br /> 8' <br /> ❑� It a tl 1< li rL µlun�i 3�b rA/5 unit 5 <br /> 9 321 10. 13Unit6 <br /> 1. int 0, y <br /> psclfic Date Range of Information Requested: From <br /> .1 ENVIRONMENTAL HEALTH DEPARTMENT FILES JeI2l�� <br /> adG UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑ SOLID WASTE FACILOYIYEHICLE <br /> A OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ra WASTE TIRE 3 /� <br /> UNDERGROUND TANK(MONRORINatREMOVAL)OT' 0DOD KENNEL 13 DAIRY Ii(J' . <br /> XHA.TARDOUS WASTE GENERATORO` 0 CHICK (L <br /> EN RANCH ❑WASTEwATEq TREATMENT PLANT <br /> 13 TIERED PERMUTED <br /> RCING ITY ❑MOTEUHCTEL 130 _G <br /> PUMPER TRUCKIYARDICHEM TOILETS . <br /> C3 TAT700le0DY PIERCING C3POOLISPA ❑LAND USE APPLICATION SITES �Iy <br /> MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY SAO AM-5:OOPm - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to_(209)464-0130 or mall to the address indicated above Address <br /> ranges will not be accepted-for additional assistance with Nle addresses,contact the EHD. Applications received after <br /> 3;00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD file]exist., An appointment for review will be confirmed approximately ten(10) <br /> p'e <br /> days after receipt of application, The files'will' held foe amaximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A new application may be <br /> 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 of the applicant. <br /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> oB - a <br /> EHO 46.06 B/04/08 <br /> PUBLIC RECORDS RELEASE APP FORM <br />