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07/03/201_2 10:07 FAX 559 442 5081 KLEINFELDER 002/002 <br />DATE RECEIVED <br />SAN JOAQUIN COUNTY EHD 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 />7TAPPLICANT: l (� 4 BUSINESS/AGENCY: <br />ADDRESS: 5126 R Ga.+eS kYL CITY/STATE/ZIP; �&no , Q37aa <br />PHONE (1): 650( 45(p b -pp PHONE (2): 550( C114 ((OZ FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: <br />(Please allow 10 business days from date of application submittal - Tentative onlyTime: <br />be: <br />-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 <br />i� <br />Electronic <br />Information: <br />❑ List ❑ Map -Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />City <br />Street # <br />Street Name <br />1. <br />2e JL)' <br />❑ Unit 1 <br />2. <br />3. <br />l ui' ' { l�» <br />Unit 2 <br />\ J L Lj <br />4. <br />a/ C �� <br />5. <br />� <br />�ft✓ / <br />Unit 3 <br />Lkt7 T <br />6. <br />7.lG <br />/ <-0 Unit 4 <br />l� <br />9. <br />Unit 5 <br />1 <br />10. <br />S ifi <br />D t <br />❑ Unit 6 <br />1 <br />pec c Date, mange of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />OU DERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACT TIIINEHI LE <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ WASTE TIRE 5 k IPJ � <br />@UNDERGROUND TANK (MONITORINGIREMOVAL)!� ❑ DOG KENNEL v,,� <br />❑DAIRY Y�,-,_lq-1 2_ <br />S�AZARDOUS WASTE GENERATOR i ❑ CHICKEN RANCH ❑/ WASTEWATER TREATMENT PLANT <br />:1 TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEMICAL TOILETS�� <br />Vit` �❑ TATTootBODY PIERCING ❑ POOL/SPA ❑LAND USE APPLICATION SITES l <br />�❑ MEDICAL WASTE FACILITY ❑ COMPLAINT RECORDS ❑ OTHER (PLEASE SPECIFY) <br />j v WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 Am -5:00m (EXCLUDING HOLIDAYS) <br />> 1. List u to ten addresses in the space above. Select the <br />P type(s) of files from the list above by checking the appropriate �; q, <br />N <br />box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address Indicated above Address ;n <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 ma X no be immediately available for review. A new application may be t '� <br />submitted when the file Is available. (' PP y <br />�4. Any file not returned in the same condition as rete ed wil be?rebrganized by EHD staff at the expense of the applicant. <br />Future file reviews by the same applicant may re ire a $125 deposit prior to review. <br />D USE <br />s <br />Recei-ved Time -Jul. 2012-11:04AM_No, 0129 7.11-17,�(:n(-'s <br />- - M --z 1, F�t/J A le- hr Std 3? -fi>-PGy i - rd <br />