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AUG-28-2007 12:33P FROM:GEOPHAI'- ENV 2095690295 - 640138 P.2 <br /> Lo SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTME <br /> AUU 2 g 2007 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202 <br /> �;i��Ef�i Fid r;;7 ctephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov. <br /> fNiROi+ <br /> pEF;P.1i i I;t ,ViCES PUBLIC RECORDS RE <br /> LEASE APPLICATION / <br /> APPLICANT: %t�l,l� L?'M r BUSINESS/AGENCY: 0' Y +. v <br /> ADDRESS: p '40'e_— <br /> PHONE(1): PHONE(2): FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: /f' ! <br /> (Please allow 10 business days from dato of applicatlon submittal-•Tentative onlyl-must be confir d)r`' ; <br /> %1417 M CHECK BOX TO EXPEDITE REQUEST-$95.00 EE(CASH R CHECK ONLY)-RE T PROCESSED IN S BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ll <br /> DATE <br /> Electronic information: ❑ List❑ Map—Descriptio <br /> FILE ADDRESS _ _ EHD USE ONLY <br /> Street# Street Name City Cl Unit 1 <br /> 2. <br /> ❑ Unit 2 <br /> 3. \ <br /> 4. ❑ Unit 3 <br /> ti nit 4 <br /> 7. . <br /> 8. --- El Unit 5 <br /> tr. <br /> ❑ Unit 6 <br /> 10. <br /> { <br /> ,I <br /> Spoclfic Date Range of Information Requested:F to d. <br /> ENVIRONMER7AI HEALTH DEPARTMENT FILES , ", <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUPS ITE(NON-LOP) ❑ FOOD FACILITY 0 WASTE TIRE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY 0 MOTEL/HOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING O POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY O 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 addrosses In the space above. Select the typo(s)of flies from the list above by chocking the appropriate <br /> box(os). At least one file type MUST be selected. Fax to(209)464-0138 or mall 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 appllcant 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 buslnoss 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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48.08 9/13/2006 <br />