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06/].4/2012 14:15 FAX 559 442 KLEINFELDER . U001/001 <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY eo <br /> ENVIRONMENTAL HEALTH DEPARTMENT / 0 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> „I,_lii )14 M Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjg()V.org/ehd <br /> m PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESS/AGENCY: <br /> APPLICANT: -77� 12_,4-71Z <br /> CITYISTATEIZIP: <br /> ADDRESS: /iir-I 0 r PCA1 9 371 <br /> ( 7 ���jL FACSIMILE: SS9� zfzh2 —s�g� <br /> PHONE(1): 554_ 577- 14-59 PHONE(2): � 9 G4 Time: <br /> TENTATIVE'APPOINTMENT DATE: ust be confirmed) <br /> (Please allow 16 business days from date of application submittal-'Tentative only-m <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECKONLY)-REQUEST PROCESSEDDAT IN 3 BUSINESS DAYS l /� <br /> SIGNATURE OF APPLICANT <br /> Electronic Information: ❑ List❑ Map-Description: <br /> EHD USE ONLY <br /> FILE ADDRESS El Unit 1 <br /> street# <br /> Street Name City <br /> �OfrJe�seh Ca c <br /> 1• y � ❑Unit <br /> 2. �l C O "IbGILb tJ � <br /> 11 <br /> 3. 2 c//-I[ r rw <br /> OCH-t! tl-� O 0/Umt3 <br /> C✓ X N 0 2/p 2 <br /> A 2 5. a�/�S L5��° ` / <br /> �. 21 a � d• <br /> Q GLS c>✓ b 2.J /Z D Unit4 <br /> 6. 00 <br /> 7. ❑Units <br /> 8. <br /> g• ❑Unit <br /> 10. to77 <br /> Speclfic Date Range of Information Requested: From <br /> ENVIRONMENTAL HEALTH D PARTMEN7 FILES SOLID WASTE FACILITYIVEHICLE <br /> `UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT [D <br /> <,[��¢+U, ❑FOOD FACILITY ❑WASTE TIRE <br /> QTHER CLEANUP SITE(NON-LOP) DOG KENNEL ❑DAIRY <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑ E]WASTEWATER TREATMENT PLANT <br /> OTELI <br /> 23IAZARDOUS WASTE GENERATOR ❑MNRANCH <br /> ❑ OTELIHOTEL ❑PUMPERTRUCKIYARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑pOOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 6:00 AM-S:OOPM(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 appropriated 464.01138 or e <br /> assistance labove.to the addr a indicated ds <br /> b ) ltleast one file Ptoed <br /> ranges wnot be accepted for additional wih file addresses,contact the EHD. <br /> 3:00 pm will be processed the next business day. t for review Will be confirmed approximately ten (10 <br /> - <br /> n <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointme <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 /> taff may not be immediately available for review. Anew application may e <br /> 3. A file that is actively being worked on by EHD s <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$125 deposit prior to review. <br /> EHO l6E ON'Y <br /> Bnitt <br /> Received Time Juu. 14. 2012 3: 11PM No, 0232 <br />