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1234 KLEINFELDER 11:22 12-03-2010 1 /1 <br /> vi. C nr_•'rIV cu MC*XAM EHD LOG NUMBER <br /> \10l�"' .J SAN JOAQUIN COUNTY <br /> � ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q- 600 East Main St, Stockton, CA 95202-3029 2.3 <br /> _�Z �y� Telephone; (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION a diT_15Sels <br /> �GP^� LICANT•____ BUSINESS/AGENCY: <br /> ,EC,tDPRESS: ���� S CITY/STATE/ZIP: rC <br /> PHONE (1 LkA - PHONE(2): <br /> 1P� ( ) �j <br /> _ FACSIMILE: 75-3y <br /> R0t0A0ATN'-'X5TAT/VE"APPOINTMENT DATE: Time: <br /> PER ��iS (Please allow 10 business days from dat f application bmittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$122 FE C SH OR CH K ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE �a��,la0ro <br /> Electronic Information: ❑ List❑ Map-Description: <br /> _ _ FILE ADDRESS _ EHD USE ONLY <br /> -Street it _ Street Name City �— <br /> cS <br /> Y-' <br /> 2. unit i <br /> 3. J <br /> -4. nit 3 1 <br /> 5 D S r <br /> Q /��gyp_ ` s_,f �1� <br /> �Lf_`k _ V-6tV�_ � � �v W� nit4 <br /> 7. <br /> 8. # .7e ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From np(1L to t`Vt�CPr�C <br /> rO—=T <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILESElROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> LEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE ( <br /> N�DERGROUND TANK(MONITORINGIREMOVAL)011�_ ❑DOG KENNEL ❑DAIRY <br /> L7nA1ARDOUS WASTE GENERATOR a ❑CHICKEN RANCH <br /> ❑TIERED PERMITTED FACILITY ❑WASTEWATER TREATMENT PLANT I Z- 7_f(� <br /> ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA <br /> ►i'tlEICAL WASTE FACILITY Ll LAND USE APPLICATION SITES <br /> ❑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 /> 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 /> 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$122 deposit prior to review. <br /> EHD USE ONLY <br /> I r C6n 5;5 inin U<11�e 'fn'e �T�� 7 <br /> a 15`o 00 <br /> IZ -ID' tAA�17 tA-0 / ,Wnim 'her r N _ -7�0 z►Z5, <br /> EHD 4"6 W �k 73 �1 f JY="'� ,/ qq1 / WO S5 3 7 <br /> 07/29/10 <br />