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04/24/2007 08:56 5302445021 LAWRENCE ASSOCToTES PAGE 01 <br /> PATE REGE[VED- - EHD LOG NUMBER <br /> SAN JOAQUI!N COUNTY <br /> ]ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E. Main Street, Stockton,CA.95202-3029 <br /> J' Telephone: (209)468-3420 Fax: (209)464-0138 Web: www,sjgov.org/ d <br /> PU13LIC RFCORDS RELEASE APPLICATION <br /> APPLICANT: USIN=S AGENCY. <br /> ADDRESS: �00 t <br /> PHONE E <br /> (2): FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Jr 3 T �-�� 4�L�, / Zp. <br /> (Please allow 10 buslness days from date c4 appl catlon submittal-•Te ust be confirmed) <br /> CHECK BOX TO EXPEDITE REQ ST-595. CASH OR CH Ll i3 ROCESSED IN 3 BUSINESS DAYS c:--Ja kCj0je. <br /> SIGNATURE OF APPLICANT 4= DATE <br /> Electronic Information: ❑ Lis Map—Description. <br /> FIL ADDRESS EHD USE ONLY <br /> Street# _eStreet Name city El Unit 1 <br /> _ <br /> 1. 10 yip ,kr1kn `'/-r < _ <br /> 2. fa iD 4� n + w�T { f /0"Unft 2 <br /> 3. <br /> 4. 1 a"7A)0 Unit 3 <br /> 6. a W �Unit a <br /> ❑ unit s <br /> _ .-. �._..__..,..�......,-- s <br /> /T <br /> 8. <br /> ------ -— <br /> Jn. c w+•IaAG d <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SrrE(LOP) 0 HOUSING ARATEMENT SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY Z WASTE TIRE <br /> LINOERGROUNo TANK(MONITORINOIREMOVAL) ❑Doo KENNEL )2-DAIRY <br /> �HAZAROOUS WASTE GENERATOR 0 CHICKEN RANCH .12rWASTEWATER TREATMENT PLANT <br /> TIERED PERMnTED FACILnY ❑MOTEUHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOOlBoOY PIERCING C1 POOLISPA (+� 0 LAND SE PPLICATION Srms <br /> 0 MEDICAL WASTE FACILITY ,Z OTHER(PLEASE SPECIFY) {J4, Qf- �1ti5. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW• MONDAY-FRIDAY 8:00 AM.4:00pM - ExCWDINO HOutiAYs. <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-(208)464-0138 or mail to the address indicated above Address <br /> ranges will not he 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 tan(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 be(ng 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 file reviews by the same applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 4e-0e en3126wan <br />