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7�- <br />EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />2 ZQ14 ENVIRONMENTAL HEALTH DEPARTMENT <br />SEB 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />�'lone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />�NVIRd�M �c��,gVIC�S <br />PUBLIC—PSC—ORQSLEASEAPPLICATION <br />APPLICADN4CP L.,1 14 A /?dV/k,1 BUSS <br />13ro <br />A 0 8- � ' CITY/STATE/ZIP: `'( a �2a <br />PHONE (1): 7(d .- (,13 _ 14 o Z 3 PHONE 31 - 2 4 w2 FACSIMILE: <br />TENTATIVE*APPOIN MENT t� . <br />(Please allows usine ss days frau ate of application sul <br />❑ CHECK BOX TO <br />SIGNATURE OF API <br />FEE GASH OR <br />_ Time: <br />- must be confirmed) <br />PROCESSED IN 3 BUSINESS DAYS <br />- -C*TE c, Z — 24 <br />Electronic Information: ❑ Li Map — Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />/ ` Unit 1 <br />Street # <br />Street Name City <br />`Vl <br />© Unit 2 <br />2' <br />3. <br />(] Unit 3 <br />4. <br />5. <br />El Unit4 <br />6. <br />7. <br />�� <br />l <br />U Unit 5 <br />8. <br />9. <br />dUnit 6 <br />10. <br />Specific Date Range of Information Requested: From to ' <br />ENVIRONMENT L HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ EDICAL WASTE FACILITY SOLID WASTE FACILITYIVEHICLE <br />OTHER CLEANUP SITE (NON -LOP) HOUSING ABATEMENT [ WASTE TIRE 3 <br />UNDERGROUND TANK (MONITORING/REMOVAL) FOOD FACILITY DAIRY U t�� <br />ABOVEGROUND TANK CHICKEN RANCH/ DOG KENNEL WASTEWATER TREATMENT PLANT <br />✓ 7 <br />HAZARDOUS WASTE/HAZARDOUS MATERIALS MOTELIHOTEL UMPER TRUCKIYARD/CHEMICAL TOILETS <br />TIERED PERMITTED FACILITY ❑ OOLISPA LAND USE APPLICATION SITES <br />TATTo01BODY PIERCING ❑ COMPLAINTIRESPONSE RECORDSOTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 �-5: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 (209) 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 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 be reorganized by EHD staff at the expense of the applicant. <br />Future file reviews by the same applicant may require a $125 deposit prior to review, ***BOXED AREA - EHD USE ONLY"* <br />Imoon <br />• ILL • l'�. fl. l i , . I �. // L/ II �` / a i <br />0 Records provided by Staff -PPR Cornlilete. Staff Name: <br />1=1074,1111.1 <br />97412 <br />Of <br />