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04/24/2067 08:56 5302445021 LAWRENCE ASSOCIATES PAGE 01 <br /> DAT,R�QEME© FHD LOG NUMBER <br /> I' SAN JOAQUIN COUNTY <br /> ENVIRONMENTAt REALTH DEPARTMENT <br /> r. - 600 E. Main Street, Stockton, CA 95202-3029 <br /> Telephone. (209)468-3420 Fax: (1209)464-0138 Web: www.sjgov,org/ _d <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: USINES AGENCY: <br /> ADDRESS:_'7,00 I b <br /> PHONE(1): J���—_ `{'�— 0PHONE(2): FACSIMILE: Sb <br /> TENTATIVE'APPOINTMENT DATE:—5L3-1-07 T ; &6.> q qj,4- 2-f <br /> (Please allow 10 business days from date of appl cation submittal..'Te a ust be confirmed) l T r <br /> CHECK BOX TO EXPEDITE REQ ST-b95.0"O-M CASH OR CH L G ROCESSED IN 3 BUSINESS DAYS c..,Ja.tc—bee <br /> SIGNATURE OF APPLICANT '�:' �{ °y DATE <br /> Electronic Information: ❑ L.is Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# t�.._`Street Name City ❑ unit 1 <br /> 1. r 0 Cl r I�+�" `/-t c C <br /> 2. 10Uq2, 11 M k. l,v/-I t unit 2 <br /> 3. flsav w/T <br /> 4. {<3 7)00 i1 Unit3 <br /> 6. h W ieUnit 4 <br /> pJ <br /> ❑ Unit 5 <br /> 9. to45 <br /> 10. 1. J`o c :.. t -- Y Jr Q C CfJtS� }s <br /> Specific pate Range of Information Requested:From to <br /> ENVIRONMENTAL_HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FAC1UrY/VEHICLE <br /> C?THER CLEANUP SrrE(NON,-OP) ❑FOOD FACILITY WASTE T)RE <br /> X.UNDEROROUND TANK(MONtTDRINWREMOVAL) C3 Doo KENNEL ;B-DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH .A'-WASTEWATER TREATMENT PLANT <br /> 15�TIERED PERMrr-Eo FACILITY 0 MOTEL/HOTEL ❑PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA ❑LAND SE}kPPLICATION SrTEs <br /> 13 MEDICAL WASTE FACILITY Z OTHER(PLEASE SPECIFY) I, ef- <br /> WELL ANP SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONGAY-FRIDAY 8:00 AM5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(&)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax_to(208)484-0138 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 S95-DO deposit prior to review. <br /> LH0 USE ONLY <br /> EHD48-" IN13t26M Woe <br />