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04/24/2067 08:56 5302445021 LAWRENCE ASSOCIATES PAGE 01 <br />QATE RECEIVED G NUMBER <br />SAN JOApu[N COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />a 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: , 16 r,\,1- ( &t -i <br />ADDRESS: 17-0c)( Mary, f-> f 0;wrct - 4 <br />PHONE (1):' LO�_�-ii-q 70 PHONE (2): <br />TENTATIVE` APPOINTMENT DATE: 5 <br />(Please allow 10 business days from date <br />X CHECK BOX TO EXPEDITE <br />SIGNATURE OF APPLICANT <br />I Electronic Information: ❑ Lisy�3 Map— Description:' <br />CY: rA wnsti 4- A--; SO a,&5 <br />CSIMIIILE-; 5j0 - Z-L1If - S0 <br />AIDe: '�feUo 7�F I �c_ (be, f_ Z p.1 - <br />subtta _ I ust be confirmed) <br />ANL - UEST PROCESSED IN 3 BUSINESS DAYS cJa,lC-bjc <br />DATE 412-311) 7;L <br />'" Specific Date Range of Information Requested: From <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUsING ABATEMENT XSOLID WASTE FACILITYtVEHICLE <br />OTHER CLEANUP SITE (NON4-OP) O FOOD FACILITY Z WASTE TIRE <br />ZUNOEROROUND TANK (MONITORINGIREMOVAL) M DOG KENNEL )S-D<uRY <br />XHAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH A2'GNASTEWATER TREATMENT PLANT <br />TIERED PERMITTED FACILITY Ci MOTEUHOTEL * ❑ PUMPER TRUCK/YARDICHEM TOILETS <br />Q TATTOol9ODY PIERCING 0 POOLISPA ((''++,� ��+ ❑LAND Ir APPLICATION SITES <br />171 MEDICAL WASTE FACILITY OTHER (PLEASE SPECIFY) Ij4,04- 4f.. I'�E[_PA_�xc_ <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AMS:OOpM - EXCLUDING HOLIDAYS. <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 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 $95-00 deposit prior to review. <br />EHt) USE ONLY <br />EHD 48-M B/1912 wnb <br />FILti ADDRESS <br />EHD USE ONLY <br />Street # <br />Name <br />City <br />p Z ❑ unit i <br />&d.,^ <br />43—J-0 )' 3 tie/ Unit 2 <br />1. <br />i 0 4i <br />�� __,1Street <br />.-69.knr_ <br />_ <br />, 4 <br />2. <br />10 $ q 2 <br />It I k <br />105-00 <br />« <br />4. <br />{O-7'hlt3 <br />", �(S( <br />" <br />URIt3 <br />�Unit 4 <br />ti <br />6. <br />7. <br />5 <br />cI ti <br />d� <br />❑ Unit 5 <br />9. <br />10. <br />�� <br />1� <br />--.� 6l ,.-._ _. _.,...,........,.... <br />T1 <br />u .f Ja <br />...... ... <br />t` <br />. <br />'" Specific Date Range of Information Requested: From <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUsING ABATEMENT XSOLID WASTE FACILITYtVEHICLE <br />OTHER CLEANUP SITE (NON4-OP) O FOOD FACILITY Z WASTE TIRE <br />ZUNOEROROUND TANK (MONITORINGIREMOVAL) M DOG KENNEL )S-D<uRY <br />XHAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH A2'GNASTEWATER TREATMENT PLANT <br />TIERED PERMITTED FACILITY Ci MOTEUHOTEL * ❑ PUMPER TRUCK/YARDICHEM TOILETS <br />Q TATTOol9ODY PIERCING 0 POOLISPA ((''++,� ��+ ❑LAND Ir APPLICATION SITES <br />171 MEDICAL WASTE FACILITY OTHER (PLEASE SPECIFY) Ij4,04- 4f.. I'�E[_PA_�xc_ <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AMS:OOpM - EXCLUDING HOLIDAYS. <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 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 $95-00 deposit prior to review. <br />EHt) USE ONLY <br />EHD 48-M B/1912 wnb <br />