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DATIM1rytJ, ���E U`, <br /> ����j 1��- EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY -mw <br /> JAN 1 6 2007 ENVIRONMENTAL ALTHDEPARTMENT <br /> 304 East Weber Avenue, 3'd Ioor, Stockton, CA 95202-2708 <br /> ENVIROVI.EN{ i1EAT01ephone: (209)468-3420 Fax: (2 9)464-0138 Web: www.sjgov.org/eh <br /> PERNIMSERVICES 27//500 <br /> PUBLIC RECORDS LEASE APPLICATION <br /> APPLICANT:((}} (tae BUSINESS/AGENCY: <br /> ADDRESS: —1 �• �' 'Q. <br /> PHONE(1):ZQ�-7446—094 !S__ PHONE(2): FACSIMILE:&!-216t4^CZZ� <br /> TENTATIVE*APPOINTMENT DATE: me: <br /> _ (Please allow 10 business days from date of appli f Ti.on submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQU 00.F H Oil CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE J—�t4r <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# .. 11 Street Name city //�� ❑ Unit 1 <br /> 1. /V, i ( °�V� 711 o2 rJ <br /> 2. <br /> ❑ Unit 2 <br /> 3. <br /> 4. - - Unit 3 <br /> 5. <br /> 6, Unit 4 <br /> 7. <br /> 8 ❑ Unit 5 <br /> 9. <br /> 10: - -❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEAL fH DEPARTMENT FILES }}.. <br /> tNDERGROUND <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 13 SOLID WASTE FACILIT*EHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑FOOD FACILI Tr 13WASTE TIRE <br /> TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL - ❑DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR 0 CHICKEN RAP CH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELPdOTE ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> TATT'OO/BODY PIERCING ❑POOUSPA ❑ LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REYI - MONDAY-FRIDAY 8:00 AMS:OOPm - 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(201 q 464-0138 or mail to the address Indicated above. Address <br /> ranges will not be accepted—for additional assistance with le 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 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 b reorganized by EHD staff at the expense of the applicant <br /> Future file reviews by the same applicant may require a$95. 0 deposit prior to review... <br /> _ - END USO ONLY <br />