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07/30/2007 12:47 -FAX 209 384 8218 KLEINFELNER a 002/002 <br />DA I3E0'EI�tO I • � EHD LOG NUMBER <br />SAN JoaQuIN COUNTY <br />:j ZOJ7 ENVIRONMENTAL HEALTH DEPARTMENT <br />600 E. Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468.3420 Fax: (209) 46w 4-0138 Web: www,s o r <br />l PUBLIC RECORDS RELEASE APPLI ION J <br />APPLICABUSINESSIAGENCY; <br />ADDRESS: <br />PHONE (1): 2-4 7 � J *Oy- '7.�r L' PHONE (i): '1 o i— isz -J y i s FACSIMILE; C Z6 <br />TENTATIVE" APPOINTMENT DATE; %a -J i.i � i D Oi Tlme: 10 : 1) � <br />(Please allow 10 business days from date or applleatlon suhmltta - •TLnt60ve only - must be conrinned) <br />❑ CHECK BOX TO EXPEDITE REQUEST- $95.00 FEE CASH OR CHECK OJ�Y) • REQUEST PROCESSED IN 3 9USINES3 DAYS <br />SIGNATURE OF APPLICANT % ` i'1i - DATE U!`� .3k -"q <br />Electronic Information: ❑ List ❑ Mpg- Deyariptlon: <br />to -ti <br />FILE ADDRESS,.1� <br />EBD USE ONLY <br />❑ SOLID WASTE FACILnYIVEHICLE <br />Streets <br />Street Name <br />city <br />1!111! 67. j-P/vt 1 unit 1 <br />c <br />ZIFIXUR0008 WASTE GENERATOR ❑ CHICKEN RANCH <br />❑ WASTEWATER TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY 71 MOTELIHOTEL <br />173 PUMPER TRUCK/YARDICHEM TOILETS <br />2. <br />13 LAND Use APPLICATION SITES <br />/� <br />MEDICAL WASTE FACILITY GATHER (PLEASE SPECIFY) A'FA's <br />t/M <br />❑ Unit2 <br />OD AM-6:0OPM - EXCLUDING HOLIDAYS. <br />Unit 0 <br />4 <br />S. <br />7, <br />❑ Units <br />B. <br />9. <br />❑ Unite <br />1M <br />Speelflc Date Range of Information Requested: From �/� 4W &'Aa <br />to -ti <br />ENVIRONMENTAL 0EALTO DEPARTMENT FILES <br />// <br />M' NDa ROROUND TANK(USTI CLEANUP SITE(LOP) HOUEINo AAATEMENT <br />❑ SOLID WASTE FACILnYIVEHICLE <br />71 OTHER CLEANUP SITE(NON-LOP) ❑FOLIO FACILITY <br />0WASTETIRE <br />1711ONOERGROUND TANK(MONITOWNOIREMOVAL) MDoc KENNEL <br />in DAIRY <br />ZIFIXUR0008 WASTE GENERATOR ❑ CHICKEN RANCH <br />❑ WASTEWATER TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY 71 MOTELIHOTEL <br />173 PUMPER TRUCK/YARDICHEM TOILETS <br />C TATTOOIBODY PIERCING ❑ PDOLISPA <br />13 LAND Use APPLICATION SITES <br />/� <br />MEDICAL WASTE FACILITY GATHER (PLEASE SPECIFY) A'FA's <br />t/M <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILAOLE FOR RENEW- MONDAY-FRnAY 6: <br />OD AM-6:0OPM - EXCLUDING HOLIDAYS. <br />1. List up to ten addresses In the Space above. Select the type(s) of flies from the list above by checking the appropriate <br />box(oe). At least one file type MUST be selected. Fix to 1209) 464-0130 or man to the address Indicated above._ Address <br />ranges will not be accepted -IRr additional aselstance with file addresaos, contact the EHD. Applications reeelved after <br />3:00 pm will be processed the next business day. <br />2. The EHD will notify the applicant If any EHD files exlat. An appointment for review will be confirmed approximately ten (10) <br />days atter receipt of application. The flies will be hold for a maximum of five business days for review. Appo)ntments <br />should be scheduled accordingly. <br />3. A flle 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 some condition as released will be reorganized by EHD staff at the expenSO of the applicant <br />Future file reviews by the same applicant may require a $96.00 deposit prior to review. <br />EHD USE ONLY <br />