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04/24/2007 08:56 53024 LAWRENCE AssocI -S PAGE 01 <br /> DATE RECEIVED - - EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> . I J 600 E, Main Street, Stockton, CA 95202-3029 /7 Q <br /> Telephone: (209)468-3420 Fax: (209)464-0]38 Web: www•sj$ov,0 d <br /> 1= r PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:y r�,.T��(a , I /,.t USINES AGENCY: 4- A-5 5a�fr�lc� <br /> ADDRESS:_ 001 flArKe - 511-1 r t I C CNU <br /> PHONE(1): Zp PHONE(2): FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Jt• 3 T : at Ci a_.It, -1- M- <br /> (Pleas®allow 10 business days from date of appl cation submittal-•jjTe ust 6e confirmed) <br /> CHECK BOX TO EXPEDITE REQ ST•b95. CASH OR CH _ JL)t%1, f q ROCESSED IN 3 BUSINESS DAYS C%Jo—tebje <br /> SIGNATURE OF APPLICANT :2c DATE 9/�J 0� <br /> Electronic Information: Map—Description:, <br /> FIL8 ADDRESS EHD USE ONLY <br /> Street X Street Name city ❑ Unit i t <br /> 1. r O y G)0.) —15 CJkAirori -/-T ver-. GI,^+ \ <br /> 2. 10 $g L n e s lA/-r I t ! Unit 2 <br /> 3. <br /> 4• {di"�hlt) —� �t Unita <br /> 6. ieunit a <br /> 7. Wit I �, <br /> --� El Unit 5 <br /> $' <br /> nn (� to <br /> 10. <br /> Speciflc Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> AUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING+AHATI;MENT XSOLID WASTE FACIUNIVEHICLE <br /> OTHER CLEANUP SITE(NON4.OP) ❑FOOD FAciury Z WASTE TIRE <br /> X.UNDEROROUNO TAW(MONITORINWREMOVAL) ❑DoG KENNEL ,O-DAJRY <br /> �HAZARCOUF�$WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY Cl MOTEL/HOTEL ❑PUMPER TRUCK/YARDICHEM TOILETS <br /> TATTOolBODT PIERCING 0 POOLISPA (� ❑LANA SE RkPPLICATION SITES <br /> 13MEDICAL WASTE FACILITY Z OTHER(PLEASE SPECIFY) �4 ^ Q� <br /> WMT,AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AMS:OOPM - EXCLUD(NO HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the types)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 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 riles exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held far 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 /> A. 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 /> II <br /> { <br /> END W" WIT2008 wan <br />