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DAT i, IeF I i �`I-I�,Vii)' EHD LOG NUMBER <br /> `�L t SAN JOAQ IN COUNTY <br /> JAM 1 6 2007 ENVIRONMENTAL ALTHDEPARTMENT <br /> 304 East Weber Avenue, 3rd Ioor, Stockton, CA 95202-2708 <br /> ENVIRONMEPdfi HEA��lepttone:(209)468-3420 Fax: (2 9)464-0138 Web: www.sjgov.org/ehd <br /> PERMiT/SER\.IICES111 <br /> ,PUBLIC RECORDS LEASE APPLICATION <br /> APPLICANT: ;e I✓c 5 INESStAGENCY: <br /> ADDRESS: [;• J ' �. c <br /> PHONE(1):zl—qzi PHONE(2): D—6 FACSIMILE: 11610-n2-1 <br /> TENTATIVE"APPOINTMENT DATE: _ Time: <br /> (Please allow 10 business days from date of applic tion submittal-`Tentative only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQU 00-17E H CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE J—SIO- D <br /> Electronic Information: ❑ List[:] Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street# Street Name city ❑ Unit 1 <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 HEALTH DEPARTMENT FIL15S ,g� <br /> �1 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABALID ABATEMENT ❑SOWASTE FACILIMYEHICLE <br /> 1S.,'.,•,xCrrOTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILr Y 11 WASTE TIRE <br /> w UNDERGROUND TANK(MONUORINGIREMOVAL) ❑ DOG KENNELDAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN CH O WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACnM O MOTEL/HOTE 11 PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOOIBppY PIERCMG ❑ PIS <br /> OOLPA ❑ LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY O OTHER(PLE X SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVI - MONDAY-FRIDAY 6:00 AMS: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 20 464-0138 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 pointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a aximum 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 f e 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 /> EHD USE:ONLY <br />