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06/14/2012 14:15 FAX 559 442 5081 KLEINFELDER Q001/001 <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> OVM ENVIRONMENTAL HEALTH DEPARTMENT 170 <br /> 1868 East Hazelton Avenue, Stockton, CA 9520506 232 d <br /> 10 <br /> „I�A A Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/eh <br /> d1�1 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �� /L� _ �� BUSINESS/AGENCY'_ <br /> 93 <br /> ADDRESS: ��!"� 0 /'- <br /> -r � CITY/STATE/ZIP: 701 <br /> PHONE(1): �� 7 77— l!j-5g PHONE(2):y �- ��t� _ FACSIMILE: JS� 4«f2 —S�g1 <br /> Time: <br /> TENTATIVE*APPOINTMENT DATE: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECKONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS l / <br /> SIGNATURE OF APPLICANT DAT L <br /> Electronic Information: ❑ List❑ Map—Description: <br /> EHD USE ONLY <br /> FILE ADDRESS <br /> street# Street Name City 1 <br /> 0 �. <br /> Unit <br /> 2. �( C O 'R�C.I�b r J ❑ 2 <br /> IlVS 4. !J 06J c �'m� <br /> d vtkt, Lint <br /> 6. Ap Q GLr o1 unit 4G� <br /> 7. t c T z', Nv cD/tea 1111 <br /> ❑Unit 5 <br /> 8. <br /> 9. <br /> 10. <br /> ❑Unit6 <br /> to <br /> Specific Date-Range of Information Requested: From <br /> ENVIRONMENTAL HEALTH D PARTMENT FILES SWASTE FACIUITYNEHICLEv <br /> 'RIUNDERGROUND TANK(UST)CLEANUP SrrE(LOP) ❑HOUSING ABATEMENT ❑ OLID _12� <br /> OTHER CLEANUP SITE(NON LOP) ❑FOOD FACILITY ❑WASTE TIRE ^}Y�DAIRY G �,�/�1r� C <br /> NDERGROUND TANK(MONffORINGIREMOVAL)t�� ❑DOG KENNEL ❑WASTEWATER TREATMENT PLANT Y Jl <br /> �IAZARDOUS WASTE GENERATOR O� ❑CHICKEN RANCH <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPERTRUCKJYARDICHEMICALTOILETS <br /> ❑POOUSPA E]LAND USE APPLICATION SriES <br /> ❑TATTOO/BODY PIERCING OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS <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 209 464-0138 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 /> f five business days for review. Appointments <br /> days after receipt of application. The files will be held for a maximum o <br /> should be scheduled accordingly. <br /> not be immediately available for review. Anew application maybe <br /> 3. A file that is actively being worked on by EHD staff may <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$125 deposit prior to review. r'Sa <br /> �C a , =_ <br /> - IZ'- rI d e p <br /> /_?�.tf LOP <br /> Received ime Jun. 14. 012 3: 11PM No. 0232#,,5 -76tq, I�G3, Ibll3j Z18 ,. L�l�Zi31' Ub <br /> T3W A <br />