Laserfiche WebLink
Gf=KOVI Geo-Phase Ernarorr%ntal •. t—5 NU. mei a-ttiU2`_+� �t-,y <br /> �l 0 V)nu U\ <br /> �� r`I SAN JOAQUIN COUNTYPUBLiC HEALTH SERAUS <br /> flrf ENVIRONMENTAL HEALTH DIVISION �� <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)4683420 <br /> /PUBLIC RECORDS RF-LEASE APPLICATION <br /> APPLICANT'_�%P✓CI��" TO� _9USINESSSIIAGENCY � �&re <br /> ADDRESS_p?�W6*1F.q <br /> PHONE FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 to 0 business day -3 ate of appllwt°o^submittal} <br /> T5 / <br /> CHECK BOX TO EXPEDITE REQUEST-$73.00 FEE-REQUEST PROLES ED/IN 3 BUSINESS DAYS. <br /> SIGNATURE OF APPLtCAN 41 DATE ! G <br /> FILE ADDRESS <br /> , O <br /> - -- <br /> 4 <br /> I- <br /> �II <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> -UNDERGROUND TANK(usT)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> J$DTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 'UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASP)•:GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL l7 PUMP ERYRUC <br /> ❑ TATTOOIBODY P41RCING t7 POOUSPA ❑ LAND USE APPLLICCAIATTIONION SITES <br /> MTOILETS <br /> ❑ MEDICAL WASTE FACILITY ❑ PUeLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses(n 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 12091 484-0138 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 Elie reviews by the same applicant may require a $78.00 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 /> EN 00 14 41MU 0 <br />