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From:Kleinfelder 209 575 3444 07'07/2011 12:41 x;100 P.0011,001 <br /> RECEIVED <br /> DATE RECEIVED EHD LOG NUMBER 4% <br /> u,� 7 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL HEALTH 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ko\( _ BUSINESSIAGENCY:� <br /> ADDRESS: — J-- /Q'I /01--' �ywC CITY/STATE/ZIP: '� <br /> 6dP <br /> PHONE(1): 577 q33�5 PHONE(2):_ FACSIMILE:— <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business daysfrom d of application submittal-'Tentative only-must be confirmed) <br /> F1 CHECK BOX TO EXPEDITE REQUEST-$122 E (C SH OR CHE ONLY)-REQUEST PROCESSED IN 3 BUSINE S DAYS <br /> SIGNATURE OF APPLICANT DATE7171, <br /> _M <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESSEHD USE ONLY i <br /> Street# Street Name _ City I. <br /> ❑Unit 1 <br /> 2. <br /> unit 2 <br /> 3. <br /> 4' <br /> 5. <br /> -- --- YJ Unit 4 <br /> 6. <br /> 7. ------------------— ------------- <br /> 8 - ----- - -------- []Unit 5 <br /> r9 g. - - <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT <br /> r?NDERGROUND TANK ER CLEANUP SITE(NON-LOP) ❑Fool)FACILITY El SOLID WASTE FACILITYNEHICLE <br /> MONITORINGIREMOVAL [:1 WASTE TIRE <br /> �--y�- ( ) El KENNEL El DAIRY <br /> LJ QARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELNOTEL ❑PUMPER TRUCK/YARO/CHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA 1❑-rAVD"USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑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(209)464-0138 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 /> EHO USE ONLY <br /> EHD 48.06 <br /> 07!29!10 <br />