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04/24/2007 08:56 5302445021 LAWRENCE ASSOCIATES PAGE 01 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E, Main Street. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: wryvw,sjgov.org/ d <br /> PUBLIC RECORDS RELEASE APPLICATION � <br /> APPLICANT: USMIES AGENCY: l_ri�, I'Ze✓� 4— A JSpkra4CS <br /> ADDRESS:_-�Z.OD( f 1(lr' eA-- <br /> PHONE(1):.'j?�l� '{�- D- PHONE(2): SIMILE: 530 ^Z.LE'-f-50 2 <br /> TENTATIVE'APPOINTMENT DATE: 51-36 ` e: 1et3�Aa Cj ��Ik ZP <br /> (Please allow 10 business days from date of appl cations b a P• TeRta' my-must he confirmed) <br /> CHECK BOX TO EXPEDITE REQ ST-595. CASH O -REQUEST PROCESSED IN 3 BUSINESS DAYS e J-,ACJole, <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information. ❑ Lis Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# jt*r Name city ❑ Unit i <br /> 1. f p ip u 1 e—RM.*dk 17 I - <br /> 2. t� U`l 4 ?Unit 2 <br /> 3. 05-00 <br /> Unit 3 <br /> 5. � I J `-' - Unit4 <br /> 6. <br /> 7. r F ° <br /> �-�r ❑ unit S <br /> 8. L�_p__. <br /> 9. a0 t� <br /> /�D- -------.. Unit 6 <br /> Specific pate Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT RISOLID WASTE FACILRYIVEHICLE <br /> t7rHeR CLEANUP SITE(NON-LOP) O FOOD FACILITY Z WASTE TIRE <br /> �UNDERQROUND TANK(MONn'OR(NOIREMOVAL) CI Dor,KENNEL 10-DAIRY <br /> HAZARDOUS WA3tE GENERATOR ❑CHICKEN RANCH 2 WASTEWATER TREATMENT PLANT <br /> "XTIERED PERMITTED FACILnY In MOTELIHOTEL O PUMPER TRUCKIYARDICHEAt TOILETS <br /> CI TATrODI9DDY PIERCING 0 POOLISPAEl LAND U}_E APPLICATION SITES <br /> 17 MEDICAL WASTE FACILrTY /l OTHER(PLEASE SPECIrY)�"Ol . � <br /> Qf f "C.P%!5E_ <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 9:00 AM5:OOPM - EXCLUDINO HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Salect 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 riles 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 /> LHO USE ONLY <br /> EHD 48-00 B11312 z. <br />