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07/03/2012 10:07 FAX 559 442 5081 KLEINFELDER U002/002 <br />DATE RECEIVED <br />SAN JOAQUIN COUNTY END LOG NUMBER <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: �� he*l At ldys BUSINESS/AGENCY: <br />ADDRESS: 5126 R Ga,+es NVe CITY/STATE2iP: T�rayl b , LL Q�j7aa <br />PHONE (1): 65R 45(Q b"%gyp PHONE (2): 650( IR[( -e 11CpZ FACSIMILE: 65-cl LILLZrj(Fri <br />TENTATIVE' APPOINTMENT DATE: <br />Tentative only (Please allow 10 business days from date of oatlon appllsubmittal - y Time: <br />y -must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST -$125 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT AATC �1C;f/�„ <br />Electronic Information: ❑ List ❑ Map — Description: <br />Street # <br />FILE ADDRESS <br />EHD USE ONLY <br />Il <br />Street Name City <br />1, <br />C <br />❑ Unit 1 <br />2. <br />�0/o <br />r� <br />!� <br />l7 tiM3.lial i.fit2 <br />I <br />5. <br />/ /� <br />Ll T <br />L�, t <br />. unit $ <br />`7' ; l7 <br />s. <br />G <br />7. <br />rL)f'%L' <br />_ <br />/ <br />icc �L�G <br />€t-.. ~^ ���.,£_r.. <br />A <br />Q <br />Unit 4 <br />C (Mp �Unit5 <br />8. <br />Of f <br />9. <br />J <br />10. <br />Specific <br />Date Ranaa of <br />infnrr .con oe,....� ,. C__— <br />❑Unit 6 <br />_.... .......w LJU65.vu. 1 /Intl to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />NDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACT i1YIVEHI LE <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ WASTE TIRE ' j lP J fV/" 6X. <br />UNDERGROUND TANK (MONITORING/REMOVAL)01- ❑ DOG KENNEL ❑ DAIRY q <br />HAAZARDOUS WASTE GENERATOR � ❑ CHICKEN RANCH 0 WASTEWATER TREATMENT LANT Jj <br />TIERED PERMITTED FACILITY ❑ MOTEL(HOTEL ❑ PUMPER TRUCK/YARD/CHEMICAL TOILETS- <br />TATT00/BODY PIERCING ElPOOL/SPA <br />MEDICAL WASTE FACILITY ❑ COMPLAINT R❑LAND USE APPLICATION SITES "'I <br />RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:0OPM (E)(rri i Inirur: <br />� 1 <br />4� <br />2. <br />�3. <br />N <br />i <br />S-' <br />List ua 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 (2091464-0138 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 />The EHD will notify the applicant if any END 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 />1Z <br />�r <br />A file that is actively being worked on by EHD staff ma no a immediately available for review. Anew application may bet! submitted when the file Is available. � (� i �i i , <br />�i <br />Any file not returned in the same condition as rete ed wil b rekrganized by EHD staff at the expense o th applicant. I <br />Future file reviews by the same applicant may re ire a $125 deposit prior to review. r <br />affmo <br />D USE <br />Received Time—Jul, 2012-11;04AM_N o. 0129 7-I <br />_ .- -- Ale- h,- 3y 3Z }h�ol <br />