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ISO 06/14/2012 14:15 FAX 559 442 5081 KLEINFELDER U001/001 <br />r <br />■ <br />■ <br />■ EHD LOG NUMBER <br />■ DATE RECEIVED <br />�. SAN aIOAQUIN COUNTY �? <br />E. �,r 1 ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: WWWsJgov.org/ehd <br />k� PUBLIC RECORDS RELEASE APPLICATION// <br />APPLICANT: �� /L � aA mal BUSINESS/AGENCY: � Ae- 14 �c l dl{e if-, <br />ADDRESS: l �C'1 O �St � t`'ei� CITY/STATEIZIP: Q � 12 �.i��?_� /37v1 <br />PHONE (1): 2- S 77 - ! PHONE (2):_5 S - �o�t� 72 FACSIMILE: J S%� ��f 2 <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal -'Tentative only - must be confirmed) <br />F1 CHECK BOX TO EXPEDITE REQUEST - $125 FEE (CASH OR CHECKONLY) -REQUEST PROCESSED IN 3 BUS/INET S DAYS <br />TS �•f�l�• <br />;1 <br />!�5 <br />SIGNATURE OF APPLICANT <br />Electronic Information: <br />El List ❑ Map - Description: <br />f I f ation Requested: rrom <br />DA <br />9/L <br />Specific Date Range o n arm <br />ENVIRONMENTAL HEALTH D PARTMEN7 FILES HOUSING ABATEMENT <br />� (�✓ � . / <br />❑SOLID WASTE FACILITYNEHICLE <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ ❑WASTE TIRE <br />DOG KENNEL y <br />OTHER CLEANUP SITE (NON LOP) ❑ FOOD FACILITY�^�`' ✓ �� - <br />❑ DAIRY Z <br />NDERGROUND TANK (MONITORINGIREMOVAL);� ❑ WASTEWATER TREATMENT PLANT' s <br />�Il <br />AZARDOUS WASTE GENERATOR l� ❑ CHICKEN RANCH ❑ Y <br />❑ MOTELIHOTEL E]PUMPERTRUCK/YARDICHEMICALTOILETS <br />❑TIERED PERMITTED FACILITY <br />❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />F-1TATTOOIBODY PIERCING OTHER (PLEASE SPECIFY) <br />F1 MEDICAL WASTE FACILITY ❑ COMPLAINT RECORDS ❑ <br />13 Ain RCr nRnS ARF AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM -5:0013M (EXCLUDING HOLIDAYS) <br />1. List u 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 s, contact the EHD. Applications received after <br />mail to the address indicated above. Address <br />ranges will not be accepted - for additional assistance with file addresses, <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 />not be immediately available for review. Anew application may be <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 retumed 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. <br />C1 I <br />I&L <br />In f - i i'• 1�'I <�/I C 7r , ,' 4 ' I `!C r n%11 c_,ni A 1 <br />5 ir <br />Received Time Jun, 14, 2012 3:11PM No. 0232A> -76(ci, II(�'�, 11N>> Z16)1� L ZUL�✓3i�fJ�/ 2U071 <br />3 5► u� ; � -i n t�� t�-W' .�i t �' _s . �� <br />