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tmu LOG NUMBtR <br /> DATE RECEIVED SAN JOAQTTIN COUNTY <br /> -f D uARTMEOT <br /> ENVIRONNIENTALI U AlTi <br /> 600 East Main Strcet, Stook-ton, CA 95202-2703 <br /> Telepboile! (209)468-3420 Fax: (209) 464-0138 Web: t"vw-sjgov.o <br /> fTTF/q <br /> —p,'. T!',�-RVI!CL PUBLIC RECORDS RE LEASE APPLICATION <br /> APPLICANT: R11'L V BUSINESS/AGENCY: <br /> ADDRESS: S&44 d114,C <br /> PHONE(1) ��)6901 PHONE(2): 71V' ACSIMILE; =2 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> XCHECK BOX TO EXPEDITE REQUEST- FEE(CASH 0 K ONLY)-REQUEST PROCESSED IN 3 BLISIV0AESS DAYS <br /> 74 �# , ; <br /> SIGNATURE OF APPLICANT DATEM91—73 <br /> Electronic Information: [I List El Map—Description: <br /> FILE ADDRESS ..,,.EHD USE ONLY, <br /> Street# Street Name city <br /> U <br /> 2. <br /> 3. nit 2-A) <br /> Unit 3 <br /> UM R3 <br /> 4. Al <br /> a G <br /> Unit <br /> 4 <br /> nit 4 <br /> 6' <br /> 7, )�Ijlel-)qAj JQ Ne� EJ unit 5 <br /> 9. Cl Unit 6 <br /> 70.,-- <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> OTHERNbERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE IF ACI&I <br /> OTHER CLEANUP SITE(NON-LOP) 11 FOOD FACILITY 0 WASTE TIRE <br /> NbERGROUND TANK(MONITORING/RcMOVAL) 0 DOG KENNEL M DAIRY ENT PLANT:�v <br /> A7ARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATFRTREATM <br /> ou 0 PVMPFRTRUCKfYARD1CHEM TOILETS <br /> El TIERED PERMITTED FACILITY 0 MOTEL]HOTEL <br /> * TATr001ROOY PIERCING El POOIJSPA 10 LAND USE APPLICATION SITES <br /> * MEDICAL WASTE FACILITY M OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8;00 Am,5!OOPM - EXCLUDING HOLIDAYS, <br /> 1. List up to ton 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 (tog)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 EHID 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 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$58.00 deposit prior to review. <br /> EHD USE ONLY <br /> If You should need further, assistance Please contact Diane Martinez E? (209)468-3429 directly- Thank You*** <br />