Laserfiche WebLink
>� Ii ILL-ED SAN JOAQUIN COUNT <br /> ✓IRONyIENTAL IIE EHD LOG NUMBER <br /> EP 1 2 20j�3 304EWeberAve3rd ALT7c to IV, <br /> NVIHL)%IENT HEALTH468 3420 Fax: (209) 464-0138 Web r Stockton <br /> '-" , CA 95205 <br /> "ERM( (SERVICES w co•sanloaquin.ca.us/ehd <br /> PUBLIC RECORDS LEASE APPLICATION <br /> APPLICANT.. 1 C ATIO <br /> oa N I <br /> BUSINESS/AGENCY: C LI pr <br /> ADDRESS: Ec,rl I PHONE: <br /> FACSIMILE: Z Z y 0 <br /> TENTATIVE-APPOINTMENT DATE: 3 <br /> (Please allow 10 business days from date <br /> a'/CHECKof Time: <br /> ECK BOX TO - ` ePPllcetlon submittal <br /> EXPEDITE.REQUEST- 93.1)0 FEE— � <br /> REQUEST PROC <br /> SIGNATURE OF APPLICANT PS SED IN 3 BUSINt:,SS-DAYS <br /> —DATE, 1 <br /> . .FILE ADDRESS . <br /> , : , _ Department Use On <br /> 1. Street C 're Cl -. ly <br /> 2. s «1 25Z C ° c' -Sro UNIT <br /> q ny`r an <br /> 3. Street Ci Q C <br /> - <br /> <. ❑ Unit 1 <br /> Street � � <br /> 5. StreetG <br /> Q - �' L✓ <br /> ^ J -❑ Unit 2 �,'�• <br /> 6. Street L �L <br /> 7. Street 3 �(,�J <br /> 6. Street 2 S G <br /> 9. street ° Unit 4 <br /> C <br /> 10. Street � �. . <br /> Q Unit 5 <br /> ENVIRONMENTAL HEALTHw. DEPARTMENT FILES J 65 <br /> [ OTHER CLEANUP <br /> TANK(UST)LOP)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY_. <br /> �THER CLEANUP SITE(NON-LOP)--- � � '` ��❑ FOOD FACILITY--- � - <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL --SOLID WASTE VEHICLE - - <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ DAIRY <br /> ❑ TIERED PERMITTED FACILITY ❑ ❑ PKG TREATMENT PLANT <br /> MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM <br /> 11TATTOO/BODY PIERCING ❑ POOL/SPATOILETS <br /> - ❑ LAND USE APPLICATION SITES <br /> 1. <br /> MEDICAL WASTE FACILITY - ❑ 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) 464-0138 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 /> . rwm worked on by EHD staff may not be immediately available for review. Anew <br /> application may be submitted when the file is available. <br /> 4• Any file not returned in the same condition as released will be reorganfied 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 /> REVIEW DATE . . . <br /> Eno�aa2aas �q—/-•�_ /}')•`IiZ ai:.S -i3 - of -I- G m�D Gotn.nTr�..� (�t(o <br /> 1- <br />