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0 ml'*02/17/2014 15:04 FAX 559 442 5081 KLEINFELDER L0001/oU1 <br /> DATE RECEIVED EHD LOG NUMBER <br /> Illi _ SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> t'A -*.- ---- — — 1 11 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> - <br /> Ng PUBLIC RECORDS RELEASE APPLICATION <br /> I HE <br /> E L <br /> APPbEINR L/ /teeP BUSINESS/AGENCY: <br /> - IV <br /> ADDRESS: Z_ <br /> C-P_-f C r CITY/STATE/ZIP: <br /> PHONE(1): 551- 7 7-1q-S;? PHONE(2): S_L-I? FACSIMILE:S-_52j 4rey2 <br /> TENTATIVE*APPOINTMENT DATE: <br /> )'/ Time: <br /> (Please allow 10 business days from date of appliciftl6n submittal-*Tentafive only-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 /> DATE <br /> Electronic Information: E) List E] Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Q Unit 1 <br /> 1. 4t 91V-5, a e 2/1)6 <br /> 12. '*C? Q unite <br /> 3. e. 4 U�' ­# <br /> au &4. tt9 67 6K—, Cf,7,i;0' r� r-, 1vtccw Unit 3 <br /> 05. <br /> 66. <br /> trnit 4 <br /> Qcw <br /> 41W <br /> tjm-AQ bX:1CC"--f0 units <br /> 9. <br /> 7, <br /> , I'A le,r- <br /> Vte I _V�Ouwmtt <br /> r10 �e <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> INDERGROUND TANK(UST)CLEANUP SITE(LOP) El MEDICAL WASTE FACILITY ❑SOLID WASTE FACILrry[VEHICLE <br /> 2- <br /> Pot"EIR CLEANUP SITE(NON-LOP) [I HOUSING ABATEMENT El WASTE TIRE <br /> 0 1)1 C.D <br /> ERGROUND TANK(MONrrORINGIREMOVAL) El FOOD FACILITY ❑DAIRY 1 <br /> = <br /> BgVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT <br /> PLANT <br /> M <br /> Lf�WAZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTELIHOTEL []PUMPER TRUCKNARDICHEMICAL TOILETS <br /> F TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> El TATTOOIBODY PIERCING El COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <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 /> kr\ <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(110) <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 /> S k� <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 appl'!can t <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> W­ <br /> X <br /> C <br /> n k <br /> -a <br /> 54 <br /> `11��il cob <br /> C)Atrr <br /> pro i ick <br /> C& X4-7-3? 10 <br /> rj*,!2104 141Z Li- r", L/'0 4-A 1�I <br /> r <br /> V3 F vadai-I oo +t) f e,51 )w L415�T f7je [10,1 1104F <br /> Wa kT1 co , . Med I 0a U #V1' fo <br />