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04/24/2067 08:56 5302445021 LAWRENCE ASSOCIATFc PAGE 01 <br /> DATE RECEIVED - FHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> r 600 E. Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0)38 Web: www.sjgov.org/ d <br /> r PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: USINES AGENCY: to ai/ �- SO G,lcS <br /> ADDRESS:--2,001 frwt.4 VeJA t U I <br /> PHONE PHONE(2): Al SIMILE: 30 ^Z.Lot-$O ZI <br /> TENTATIVE'APPOINTMENT DATE: Jr 3 e: pt{e� 4_(LL,4- <br /> (Please allow 10 business days from date of appl cation » e W my,.must be confirmed) <br /> ,1111111110A - k: <br /> CHECK BOX TO EXPEDITE REQ ST-$95. CASH OFW.�K" -REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> ,y <br /> SIGNATURE OF APPLICANT '- DATE <br /> 412-31b 7- <br /> Electronic Information: ❑ Lis Map—Description: <br /> FIL5 ADDRESS EHD USE ONLY <br /> Street fF t�-,Street Name, I city ❑ Unit t <br /> 1. f 0 Li tiM^Adk t� r_ <br /> 2_ p u n e s 1 �unit 2 !) <br /> 4. <br /> la-7h0 I) R I Unit 3 <br /> 6. �5� �ry - ')q _ Unit a <br /> (p <br /> 7. a l ) fir"' F 4, <br /> ' ❑ unit 5 <br /> 9. f <br /> 10. is 1, t5o, w SLS C tE . <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILITY/VEHICLE <br /> 0rHSR CLEANUP Sm'(NON10P) O FOOD FACILITY ;6 WASTE TIRE <br /> XUNDEROROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL )a-DAIRY <br /> HAZARDOUS 1NAs rE GENERATOR 0 CHICKEN RANCH -J2VASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTEL/HOTEL ❑PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTDOIBODY PIERCING 173 POOLJSPA ((++,, � ❑LAND SE PPLICATION SREs <br /> MEDICAL WASTE FACILITY �I OTHER(PLEASE SPECIFY)_D-'r{1I' e pti'K. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - 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 net 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 /> Q. 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 /> EHD USE ONLY <br /> EHD 48-" 911316 —b <br />