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04/24/2007 08:56 530244F-R?l LAWRENCE ASSOCIATES PAGE 01 <br /> pATlr RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E. Main Street, Stockton, CA 95202-3029 /10?Q <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjSov,org/ d <br /> __0 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:Ja, I /M1 AGENCY: � .-A w ,P 4- � Q� sskADDRESS;— �IJSINES� <br /> PHONE(1):5�0—-2-41—'13-0 7 PHONE(2): FACSIM <br /> ILE <br /> - <br /> , <br /> TENTATIVE'APPOINTMENT DATE: Jt— 3 T 3fsl-Ia� C'' <br /> (Pleas®allow 10 business days from dais of appl cation submittal-•Te ust be confirmed) <br /> ,�C CHECK BOX TO EXPEDITE RECt ST•$95. CASH OR CH L R q ROCESSEP IN 3 BUSINESS DAYS �J-,AC.bjG <br /> ~ <br /> SIGNATURE OF APPLICANT DATE � <br /> Electronic Information: ❑ USM Map—Description,' <br /> FILA ADDRESS EHD USE ONLY <br /> Street* _,Street Name City El unit 1 <br /> 1. 1 0 Ci �5�e_RaAdt n `o/-t rrC vu <br /> 'I Unit 2 <br /> 3. 105.00 �, w �- <br /> �� �Unit 3 <br /> 4. {O <br /> 5a_5��7�(o _' �Unit 4 <br /> 7. 755- ❑ unit <br /> 8. <br /> 9. Loft + <br /> A <br /> Specific pate Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> KUNDERGROUNo <br /> TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT XSoLio WASTE FACIOTYNEHICLI< <br /> O HER CLEANUP Smr(NON4-OP) =FOOD FACILITY Z <br /> r WASTE TIRE <br /> UNDEROROUNO TANK(MONiroR(NOIREMovAL) ❑DOG KENNEL ."AJRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH .2 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEUHOTEL ❑PUMPER TRUCKJYARDICHEM TOILETS <br /> ❑TATTOOIBoDT PIERCING ❑POOUSPA (n� ❑LANn Urr PPLICA'nON SRES <br /> ❑MEDICAL WASTE FACILRY OTHER(PLEASE SPECIFY) 1��4 + QF A-t <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AMS:00PM - EXCLUDINO HOLIDAYS. <br /> 1. List up t0 ten addresses in the Space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to f209)464-0138 or mail to the address indicated above.. Address <br /> ranges will not he accepted—for additional assistance with file addresses,contact the END.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 S9s-00 deposit prior to review. <br /> EHD USE ONLY <br /> ` 1 <br /> f - � <br /> EHD4$-" DMM006 wah <br />