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D C t ,i D" EHD LUG NUMBER <br /> �1���❑� ' SAN JOAQUIN COUNTY <br /> ENN'I1t,jN1\1ENTAL BEALTH DEPARTNILNT <br /> 2007 600 East Main Street, Stockton, CA 95202-2708 <br /> ���elephone: (209)468-3420 Fax: (209)464-0138 Web: wvvvv.sjgov.org/ehd 3 <br /> f`�cif u'll�lLl'Jt H"EA I.. <br /> PUBLIC RECORDS RE LEASE APPLICATION <br /> APPLICANT: S iJ K kf J!f _- BUSINESS/AGENCY: <br /> ADDRESS: 5 e `I 4?LAc-14: O i4K l oO S Tc CK --T-,, ,j C <br /> 3 <br /> PHONE(1): o�� ) — -2 7 — - 9 <br /> 1 T I PHONE(2): FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$98.00 FEE(CASH OR CHECK LY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE / 01 ja <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 2. o (4o - / i ,q t^j ,f%aL L T ❑ Unit 2 <br /> 3. <br /> 4 Nu <br /> unit 3 <br /> 5. <br /> 6. unit <br /> 7. d <br /> — -- ❑ Units <br /> 8. <br /> 9. ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> iR UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> (!� UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 11�HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> f{'I TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - 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)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted—for additional assistance with file 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 files exist. An appointment for review will be confirmed approximately ten (10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by END 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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> *** If you should need further assistance please contact Diane Martinez e (209)468-3425 directly. Thank You*** <br /> EHD 48.06 9/14/2006 <br />