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06 '14/2012 14:15 FAX 559 442 5081 KLEINFELDER 0001/001 <br /> L' <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> MM 1868 East Hazelton Avenue,Stockton, CA 95205-6232 <br /> 4,ic:Fi03 Telephone: (209)468-3420 Fax:(209)464-0138 Web:WWw.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_ 2�- ,/ ah e_KJ BUSINESS/AGENCY: /� is C/(e_"L, 3 <br /> _ 14-1 o C-- /Z r" CITYISTATEIZIP: <br /> ADDRESS: ?v� <br /> PHONE(1): jE��_ S ?7- 14.54— PHONE(2):��p- l�t� ���7Z- Time:FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECKONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> Electronic information: ❑List❑Map—Description: <br /> EHD USE ONLY <br /> FILE ADDRESS <br /> Street# <br /> Street Name City 1 <br /> 1. �e-®f W42/Ie/L � <br /> 2. PI Olt' AOL <br /> "(bt:�� Unit 2 <br /> 3 � - a 0� 1 <br /> 14715 4. A) 0 �7EUnit 4) <br /> 5. <br /> 00 <br /> ❑Unit 5 <br /> 8. <br /> 9. <br /> ❑Unit6 <br /> 10. <br /> to <br /> Specific Date'Range of information Requested: From <br /> ENVIRONMENTAL HEALTH D PARTMENT FILES SOLID WASTE FACILrIYNEHICLEd <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT r-1 <br /> ❑FOOD FACILITY ❑WASTE TIRE <br /> OTHER CLEANUP SITE(NON-LOP) DOG KENNEL ❑DAIRY <br /> NDERGRO0. <br /> UND TANK(MONTTORINGIRENIOVALY-, ❑CHICKEN RANCH E]WASTEWATER TREA 'TMENT P 1 i <br /> a�J <br /> 21IAZARDOUS WASTE GENERATOR ❑MOTEL/HOTEL E]PUMPERTRUCKIYARDICHEMICAL TOILETS <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 8:00 AM-S:OOPM(EXCLUDING HOLIDAYS) <br /> of files from the list above by checking the appropriate <br /> 1. list ua to ten addresses in the space above. Select the type(s) <br /> box(es). At least one file type MUST be selected. Fax to 209 4640138 or mail to the address indicaUeodnsbeceived afters <br /> tangos will not be accepted-for additional assistance with file addresses,contact the EHD. App <br /> 3:00 pm will be processed the next business day. roximatek (ten 10) <br /> 2. The EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed approximately <br /> days after receipt of application. The files will be held for a maximum of five business days for review. App <br /> should be scheduled accordingly. <br /> by EHD staff may not be immediately available for review. Anew application may be <br /> 3. A file that is actively being worked on <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 fhe reviews by the same applicant may require a$125 deposit prior to review. <br /> -2� L® LD000 I i d <br /> 60 <br /> c � 31'?(b 3� <br /> i Received Time Jun. 14. 012 3: 11PM No. 0232 5 � (Q, II ® 1b1� i �' � � � i <br /> 351 1.46I < (A hie_ . <br />