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06/14/2012 14:15 FAX 559 442 - 1 KLEINFELDER . 0.1001/001 <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY * O <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 O <br /> , ,Jill ) M Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> tIYVKiL4 <br /> ( � M PUBLIC RECORDS RELEASE APPLICATION / <br /> APPLICANT: �� /L 11 !V P G�t[J BUSINESS/AGENCY: l,o 14-Fe Ike <br /> Sr r-'e4 CITYISTATEIZIP: F ✓1( <br /> ADDRESS: /zCl A/p <br /> PHONE(1): p_ 577- 1ZY`22 PHONE(2): �F 9- �oZt� �.y 2 FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: <br /> Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must E confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK40NLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS t <br /> SIGNATURE OF APPLICANT <br /> Electronic Information: ❑ List❑ Map—Description: <br /> EHD USE ONLY <br /> FILE ADDRESS ❑ Unit 1 <br /> Street# <br /> Street Name city <br /> 1. /afP1se/9 Ce -cam . <br /> ❑Unit 2 <br /> 2. PICC o ' a F <br /> 3. o- G/-k -!"cw / <br /> //yy, oGfl-!} A✓ Unita <br /> lt/5 l"''/ /) 0 CrL5. <br /> 6GL` .�, (a 2J /Z ❑Unita �,i'%.�' ,. <br /> 6. ! <br /> 7. t C G :✓ <br /> ❑Unit 5 <br /> 8. <br /> 9. <br /> ❑Unit 6 <br /> % <br /> to <br /> specific Date Range of Information Requested: From <br /> ENVIRONMENTAL HEALTH D PARTMENT FILES SOLID WASTE FACIUTYNEHICLE <br /> UEl FOOD FACILITY NDERGROUND TANK(UST)CLEANUP SITE(LOP) E]HOUSING ABATEMENT <br /> ❑WASTE TIRE <br /> WN <br /> OTHER CLEANUP SITE(NON-LOP) DOG KENNEL ❑DAIRY <br /> DERGROUND TANK(MONRORINGIREMOVAL) [IDOG <br /> RANCH ❑WASTEWATER TREATMENT PLANT <br /> 271AZARDOUS WASTE GENERATOR PUMPER TRUCNIYARDICHEMICAL TOILETS <br /> F1 TIERED PERMITTED FACILITY ❑MOTELIHOTEL <br /> ❑PDOEISPA ❑LAND USE APPLICATION SITES <br /> lTATTDOIBODY PIERCING ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <br /> BLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-S:DOPM(EXCLUDING HOLIDAYS <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILA <br /> 1. List u to ten addresses in the <br /> UST be selectede Fax to 2091 ct the 464-0138 o mof files from the list above by ail to the add dress,nd checking ted aboveropriate <br /> Address <br /> box(es). At least one file type ITcations received after <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. App <br /> 3:0D 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 of five business days for review. Appointments <br /> be confirmed approximately ten(1 O) <br /> days after receipt of application. The files will be held for a maximum <br /> should be scheduled accordingly. <br /> taff may not be immediately available for review. Anew application may be <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 /> EHL•USE 0M Y <br /> al+Il� <br /> Received Time Jul, 14. 2012 3 ; 11PM No. 0232 <br />