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04/24/2007 08:56 5302445021 LAWRENCE ASSOCIATES PAGE 01 <br /> DATE RECEIVED <br /> AW&1ftdG 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: Wvw,Sjgov.org/ _d <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: USINES AGENCY: LfA a rL.�.•� -I <br /> � - � <br /> 5o sr,d�S, <br /> ADDRESS:—x,.00 Mar, � l1,0131 <br /> PHONE(1):.����--2-4ij--113f)�j PHONE(2): CSIMILE- 510 --z-qIf-50Z/ <br /> TENTATIVE'APPOINTMENT DATE: 513, e:S� q <br /> (Please allow 10 business days from date of appl cation sub tta I ust he confirmed) <br /> CHECK BOX TO EXPEDITE REQ ST-b95. O Nl;' - UEST PROCESSED IN 3 BUSINESS DAYS c:.J AC...IDje, <br /> CASH <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: <br /> ❑ Lis Map-Description: <br /> FIL ADDRESS EHD USE ONLY <br /> Street* '`Street Name city p s ❑ Unit t <br /> 1. <br /> 10 912) Akn c &P-" <br /> 2. 10 �K� n ,k .I K (-p(-3*%C�ha unit 2 <br /> • <br /> 105-00 m 404 �a •Uf�t �'t^ /� <br /> 4. 10`7h�� _ uS( __ •� Unita <br /> 06, 6. 'b so N f t!S� ' QQ..��raT^ �J�•" Unit 4 <br /> ❑ Unit S <br /> ct L4 Old i� <br /> 9. <br /> _.__.. It-------_---------- Unit 6 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SrrE(LOP) ❑HOUSING ABATEMENT IWSOLIO WASTE FACILITYIVEHICLE <br /> ,OoZOTHER CLEANUP SM(NON-LOP) ❑FOOD FACILITY W WASTE TRE <br /> XUNDEROROUND TANK(MONITORINOMEMOVAL) C3 Doo KENNEL )a-DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 2 WASTEWATER TREATMENT PLANT <br /> oTIERED PERMITTED FACILITY ❑MOTELMOTEL ❑PUMPER TRUCK/YARDICHEM TOILETS <br /> C3 TATTDolSooy PIERCING _ ❑POOLISPA (� ❑LAND SQ�APPLICATION SREs <br /> 13 MEDICAL WASTE FACILITY ,I OTHER(PLEASE SPECIFY) D-CD4 , 'df- "[CAN!5c_ <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM5:001'M - EXCLUDING HOubAYS. <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 /> EHO USE ONLY <br /> --Y7 <br /> EHD 45-00 9119/2 woe <br />