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DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL 14EALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PU LIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Terry Nephew nephew@kleinfelder.com BUSINESS/AGENCY: Kleinfelder <br /> ADDRESS: 5125 N. Gates Av -, Ste 102 CITY/STATE/ZIP: Fresno, CA 93722 <br /> PHONE (1): 559-577-1459 PHONE (2):559-647-3842 FACSIMILE:559-442-5081 <br /> TENTATIVE*APPOINMENT DATE: Time: <br /> (Please allow 10 b sines,days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125:FEE,(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OFAPPLICANT I/� �' `'"' !�,/ ,'li ;< . = �'k `DATE �5� <br /> Electronic Information: ❑ List❑ Map- Description: <br /> FI E ADDRESS EHD USE ONLY <br /> Street# treet Name City 1 <br /> [22. <br /> 400 East Main St. ! Stockton �, <br /> 47 South San Joaquin St. Stockton F�,UI/tib ' 1 El Unit 2 <br /> 3. 236 East Miner Ave f Stockton 36 U0 <br /> 4. 700 East Market St. Stockton <br /> IAN Ml 1} GO llv(�7 <br /> ❑"Unit �L�J <br /> 5. 400 South Aurora StocktonT-rL'z�/t0 <br /> . <br /> 6. 521 East Main 0 Stockton N i 1 , c 0 EJ-Unit 4 <br /> r10 <br /> 632 South EI Dorad Street Stockton ' 11 U� p 010 a) <br /> 423 North Madison Stockton - l ❑ unit 5 <br /> 402 West Weber Av Stockton. 40 Lincoln Street ,N 0 Ck ❑ unit 6 <br /> Specific Date Range of Information Re uested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP ITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEH/IC-LE f 3 <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE �hip 5 fVr <br /> ®UNDERGROUND TANK(MONITORINGIRE OVAL) ❑FOOD FACILITY ❑DAIRY 1 L, (,e, 10- <br /> ®ABOVEGROUND TANK,/_ ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ®HAZARDOUS WASTEIHAZARDOUS MATE IALSp!_ ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC P1 -` W �,,�- r Woo()q D c{ 25��Ot 510 b) ;A ti W {-,16 , (CLUDING HOLIDAYS) <br /> 1. List up to ten addr [/pp iVict WOOD 310713(PfoPb 5, <br /> 5,1 It i pti /zy/J4 C,1/Z) a L,a1�Z�cll 1 the appropriate <br /> box(es). At least( CN A T Dtf)p Q Cp,'191Fr,,a,„ Cie"up) I rl us-r iGiL ?d above. Address <br /> ranges will not be U1, rq_ Co 00 35'30.1(gyp•{ 5/C&)d- Lo DD 35 3U50t-5106� ons received after <br /> 3:00 pm will be pr( �� p/l(0s Die)0A cD/scdricd Ow kilo— Sioa y�ir7 <br /> 2. The EHD will notif do_ wW2y 8 rb�fd s,p�)d(:060;1971(� J approximately ten (10) <br /> days after receipt b-3j &1 S IL4L41. (00D03D S*,',0P(05 Oct lorey) r• Appointments <br /> should be schedu �nfi f,je (Or p,ea /� <br /> W 003600-7 � f 5 I D(0 a 3/70/b 7 01 e-)w'�,n <br /> 3. A file that is active �- � ;w application may be <br /> submitted whentl ex D0 z�' cxi3�• Q v�l�t" <br /> 4. Any file not returr y;0 M� '1 - � 905E gcrP+5'10 /� '`� 5� se of the applicant. <br /> Future file review, - �te- icant may require a$125 deposit prior to review, ***BOXED AREA-EHD USE ONLY*** <br /> 10- -I r0V' 12 , 11�1,41-) A/� Aaa4 ff7->,l <br /> c( t I r s �-X zc a b 1 {�� y� :�3w1f{1i ri <br /> ,Vu', -�, Iw► u.�1LtJ+�a0 .I' ��l 4" l.U'J'�i �fiV-61(f i5� � -� �'i0 <br /> LJ MUGUIFU5 PIUVIUVU byw <br /> FHn AR.na 12119/12 <br />