Laserfiche WebLink
04/24/2667 08:56 5362445021 LAWRENCE ASSOCIATES PAGE 01 <br /> QATiw R-Q�N ID - EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> _ - ENVIRONMENTAL HEALTH DEPARTMENT <br /> J 600 E. Main Street, Stockton,CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ ..d. <br /> "PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT' USINPS AGENCY: &w ,-o- 4" A Jap ere 5 <br /> ADDRESS:--�7_00 j DNAry, 5fl O J <br /> PHONE(1):'J?�c�.-..�.�(`� q �.0_ PHONE(2): ----- FACSIMILE: <br /> TENTATIVE•APPOINTMENT DATE: 3t- 307 A'-&LloT>'ort� C� ,f ZP.m- <br /> (Please allow 10 business days from date of aPpl cation submittal-•Teust he confirmed) <br /> 34 CHECK BOX TO EXPEDITE REQ ST-;95. CASH OR CH L /`: ROCESSEr)IN 3 BUSINESS D -AYS "o, eblG <br /> SIGNATURE OF APPLICANT r DATE <br /> Electronic Information: ❑ Lis Map-Description, <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ❑ Unit I <br /> 2. RR. (,��I 1 �Unft2 <br /> 3. <br /> 4. {Q� t1 �' �w Unita <br /> 6. $ ." a W irUnit a <br /> 7. st W r� <br /> ❑ Unit S <br /> 9. !-a,)y --�/—- Loft <br /> 1O. � P 11 ✓V. � iiM1. � r��'i �as'1. F� p � <br /> Specific pate Range of Information Requested:From to __- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNUERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING AaATEMENT ,?'SOL io WA$TE FACIUTYIVEHICLE <br /> OTHER CLEANUP SRR(NowLOP) ❑FOOD FACILITY WASTE TIRE <br /> UNORRQROUND TANK(MONtTORINOIREMOVAL) ❑Doo KENNET. ,0-DnRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 2WASTEWATER TREATMENT PLANT <br /> TIERED PERMnTED FACIL rY ❑MOTELIHOTEL ❑PUMPER TRUCKlYAROJCHEM TOILETS <br /> TATT0o15ODY PIERCING ©POOLISPA (� / ❑LAND SR PPLICATION SREs <br /> MEDICAL WASTE FACILITY ,l OTI-IRR(PL,EASE SPECIFY) LLCr{)7I', d� tC %!!5bE_ <br /> WML,ANP SEPTIC PERMIT MORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 9:00 AM5:00PM - EXCLUDINO HOLIDAYS. <br /> 1. List up to Leri 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.(2091464-0138 or mail to the address indicated above. Address <br /> ranges will not he accepted-for additional assistance with file addresses,contact the END.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 Wrig 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 EHb staff at the expense of the applicant. <br /> Future rile reviews by the same applicant may require;i$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-a WW26M ,voh <br />