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04/24/2007 08:56 5302445021 LAWRENCE ASSOCI PS PAGE 01 <br /> QATE RECEIVED-- G NUMBER <br /> SAN JOAQUIN COUNTYit )nn7 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> n"7 600 E. Main Street, Stockton,CA,95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-01.38 Web:www.sjgov.orW ..d <br /> LOO <br /> PTJ LIC RECORDS RELEASE APPLICATION <br /> PLICATION <br /> APPLICANT: USINES AGENCY: <br /> ADDRESS:_-7_001 f 1 Xdr d -- 1q ioo 1 <br /> PHONE(1): PHONE(2): CSIMILE; <br /> TENTATIVI*`APPOINTMENT DATE: 5-13/ <br /> ZP n�- <br /> (Please allow 10 business days from date of apps cation sub tusi be confirmed) <br /> CHECK BOX TO EXPEDITE REQ ST-$95. CASH O N UEST PROCESSE13 IN 3 BUSINESS DAYS G. o—ice-be- <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ Lis Map—Description- <br /> FILI ADDRESS EHD USE ONLY <br /> Street street Name city s ❑ unit f <br /> 1 Toy <br /> 2. 1e asu <br /> nit 2 <br /> 4• 10='l"Id t3 u(2� ea "Unit3 <br /> r lop <br /> unit 4 <br /> T. cg00An <br /> a. ❑ Unit S <br /> U` S to @` �4 <br /> Unit 6 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(Un CLEANUP SITE(LOP) 0 Ho=NG ABATEMENT PSouo WASTE FAC1UTy/NEHICLK <br /> ./ QPNER CLEANUP SITE(NON-LOP) C3 FOOD FAcury WASTE TIRE <br /> X,UNOEROROUND TANK(MONITOR1NWREWWAL) 0 Doo KENNET. ;"PJRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 2rWAsTEWATER TREATwENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTELIHOTEL s ❑PUMPER TRUCKIYARvICHEm TOILETS <br /> O TATTo7oMoDY f TERCING ❑POCUSPA (� M LAND SIZ PLICATION SITES <br /> MEDICAL WASTE FACILITY �i oTNER(PLEASE SPECIFY) t�404, of- ixkm. ,L <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLMNG 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,(2")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 EMO staff at the expense of the applicant" <br /> Future file reviews by the same applicant may require a$95-00 deposit prior to revlew. <br /> EHO USE ONLY <br /> 76j07 `o�G --ft, <br /> EHD"-ft WIX2 won <br />