Laserfiche WebLink
DA,;;-: RECEIti/EU ! LI-11)LUU iVUi%i L.x <br /> SAN JOAQUINCOUNTY <br /> �p X EN r :ONMENTAL HEALTH DEPART ,NT <br /> 3E Weber Ave 3rd Floor Stockton, CA 95205 <br /> (209) 468-3420 Fax: (209) 464-0138 Web: www.co.san_joaquin.ca.us/cl1d. <br /> PUBLIC RECORDS RE LEA + APPLICATION <br /> APPLICANT: V} BUSINESSIAGEN I : I } Y tf O = <br /> ADDRESS: <br /> C <br /> PHONE: - FACSIMILE: N <br /> TENTATIVE"APPOINTMENT DATE: <br /> Time• f -; <br /> (Please allow 10 business days 4"d to of application submittal) _- <br /> H K BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS NO- -: �\ <br /> SIGNATURE OF APPLICANT HATE <br /> Department Use Only <br /> �1 F LE ADDRESS UNIT <br /> 1. Strcel ...�3 �4� -4>,f„7 '7G.;; Olt �j•� <br /> ❑ Unit 1 <br /> 2. Scree+ Cit <br /> 9- Streel Cil ' xt <br /> U/� 1 El Unit 2Je <br /> �. Slreel <br /> 5. SIleel Ci[ <br /> . ❑ nit 3 <br /> G. Slrert c <br /> 7. Strcel City Unit 4 <br /> 8, 51reel Cit , <br /> L19. street COY nit rJ <br /> 0. Street Cit <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> i ❑ ,UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FAC(LfJl/ °- <br /> ❑ OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ SOLID WAVE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) R DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> i. 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 fifes 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 a t N <br /> of the applicant. Future file reviews by the same applicant may require a $93.0 t it ` <br /> , <br /> r ?. <br /> �. *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 /> -H0 48-02-006 - <br /> BI812003 <br /> €i ' <br />