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04/24/2007 08:56 5302445021 LAWRENCE ASSOCIA .S PAGE 01 <br />PATE RQQEIV�P G NUMBER <br />SAN JOAQUIN COUNTY <br />ENVIRONMYNTA L HEALTH DEPARTM.F,.NT <br />600 E. Main Street, Stockton, CA 95202-3029 <br />f J (Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ ..d. <br />PUBLIC RECORDS RELEASE .APPLICATION <br />APPLICANT: V.qtQ0 <br />GENCY: <br />ADDRESS: _17-001 f nar e� - t1 <br />PHONE (1): J3O� �'7 O PHONE (2): ---. _ CSIMILE: <br />TENTATIVE• APPOINTMENT DATE: C9 t fes, f- Z p, M. - <br />(PieaseT allow 10 business days from date of appl catlon sub it, <br />ust he confirmed) /f r+ <br />CHECK BOX TO EXPEDITE REQ ST - 595. CASH O N VEST PROCIESSEf7 IN 3 BUSINESS DAYSJa�lckjj�, <br />SIGNATURE OF APPLICANT DATE <br />Specific pate Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />ou=RROROUNDTANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT RSOUD WASTE FACIUTYIVEHICLR <br />C1R CLeuIUP SITE (NON4LOP) C7 FOOD FAciury ;9 WASTE TIRE <br />XUNDER®ROUND TANK (MONITMWIREMOVAL) 0 Doo KENNET. ,; DAIRY <br />HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH .J2 WASTEWATER TREATMENT PLANT <br />XTRAED PERMITTED FACILITY 0 MOrEUHHoTrL * ❑ PUMPER TRUCKIYARDICHEM TOILETS <br />O TATTDoMoDY PIERCING E] POouSPA (� ❑LAND SE PLICATION SITES <br />0 MEDICAL WASTE FACILITY ,t OTHER (PLEASE SPECIry)�6 PLIC <br />WELL ANP SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AMS:00PM - EXOI.UDINO HOLIDAYS. <br />1. Lest up to ten addresses in the space above. Select the type(r) of fifes from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to.(20% 4840138 or mail to the address indicated above Address <br />ranges will not be accepted — for additional assistance with file addresses, contact the EHD. Applications recoived after <br />3:00 pm will 4e 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 EH0 staff at the expense of the applicant. <br />Future file reviews by the same applicant may require a $95-00 deposit prior to review. <br />EHD USE ONLY <br />111� l �. G7.1:i� ' ! f ! /� � �► ,, e . .- ISL <br />Electronic Information: <br />❑ Lis Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />fit.. <br />0' <br />t <br />iAA 1. <br />2. <br />+4. <br />6. <br />7. <br />8. <br />10. <br />Street TR <br />n <br />It <br />e <br />':I <br />c.r <br />90 <br />SOvet Name <br />dt L"i <br />a�. <br />V,5 -r 406 <br />V6S� <br />L( Qid tki.w <br />City <br />et <br />R � <br />q9 <br />$` <br />%i(' 01- <br />^D'"3. <br />❑ URR t <br />unft2 <br />t�Rit 1 <br />Unit R <br />❑ Unit S <br />Units <br />f ei <br />10 6 <br />105,00 <br />+. <br />`Q II V � <br />4J �-0 <br />5 <br />_20-1-- <br />µ3 <br />Specific pate Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />ou=RROROUNDTANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT RSOUD WASTE FACIUTYIVEHICLR <br />C1R CLeuIUP SITE (NON4LOP) C7 FOOD FAciury ;9 WASTE TIRE <br />XUNDER®ROUND TANK (MONITMWIREMOVAL) 0 Doo KENNET. ,; DAIRY <br />HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH .J2 WASTEWATER TREATMENT PLANT <br />XTRAED PERMITTED FACILITY 0 MOrEUHHoTrL * ❑ PUMPER TRUCKIYARDICHEM TOILETS <br />O TATTDoMoDY PIERCING E] POouSPA (� ❑LAND SE PLICATION SITES <br />0 MEDICAL WASTE FACILITY ,t OTHER (PLEASE SPECIry)�6 PLIC <br />WELL ANP SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AMS:00PM - EXOI.UDINO HOLIDAYS. <br />1. Lest up to ten addresses in the space above. Select the type(r) of fifes from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to.(20% 4840138 or mail to the address indicated above Address <br />ranges will not be accepted — for additional assistance with file addresses, contact the EHD. Applications recoived after <br />3:00 pm will 4e 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 EH0 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 />111� l �. G7.1:i� ' ! f ! /� � �► ,, e . .- ISL <br />