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07/03/2012 10:07 FAX 559 442 5081 KLEINFELDER U002/002 <br /> DATE RECEIVED EHD LOG NUMBER <br /> .� SAN .IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 lqO VW <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLICRECORDSRELEASE APPLICATION K- <br /> APPLICANT: `lam 61IX BUSINESS/AGENCY; W C!&r <br /> ADDRESS: _ (21j 9 Gafes Dae- CITY/STATE/ZIP: Q,Y,110( Cit R37aa <br /> PHONE(0 EJC( +V(9 15150 PHONE(2): 65ck RILe (L(.oZ FACSIMILE: 559 44Z6c?/ <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-must be conflrmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINE S DAYS <br /> SIGNATURE OF APPLICANTDATE si' R Z0 <br /> Efectronic Information: ❑ List❑Map-Description; <br /> FILE ADDRESS END USE ONLY <br /> DL eet III Street Name City <br /> ❑unit 1 <br /> I. wli� 2-e Lit t" <br /> 2. 0 NJ(,Itiijk2 <br /> 3• � `� 4nCI([ 7PFa �1i2{ ,NO <br /> 4. <br /> N r unit3 <br /> 5 -7 o Q( T Z> - On <br /> s rr i <br /> — i <br /> c S cis-/�0j 13/; <br /> 7. ��` Unk4 <br /> 0 Unit <br /> S 9. l <br /> ❑units <br /> in1 Specific Date Range of Information Requested: From to <br /> 11 ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> -r`1U ERGROUND TANK(UST)CLEANUP SITE(LOP) ElOUSING ABATEMENT H <br /> la El SOLID WASTE FACT N E <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY <br /> 1'n ❑WASTE TIRE 15j <br /> _ Jra—i�UNDERGROUND TANK(MONITORINGIREMOvAL)r� ❑DOG KENNEL ❑DAIRY '_ „ <br /> o- IQrwZARDOUS WASTE GENERATOR � ❑CHICKEN RANCH r1��WASTEWATER TREATMENT PLA j <br /> ❑TIERED PEUIlTTEp FACILITY ❑MOTEI/HOTEL LJ PUMPER TRUCK/YARDICHEMICAL TOILET�,(J), <br /> TATToo/BODYPIERCING POOL/SPA +_' I <br /> M ❑ ❑LAND USE SITES <br /> MEDICAL WASTE FACILITY ❑'COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW; MONDAY-FRIDAY 8:00 AM-5;OOPM(EXCLUDING HOLIDAYS) <br /> S 1. List uo to ten addresses in the space above. Select the type(s)of files from the list above b checking the <br /> box(es). At least one file Y 9 appropriate <br /> N 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 97. <br /> 3:00 pm will be processed the next business day. <br /> 2. The END will notify the applicant If any END 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 /> y 3. A file that is actively being worked on by END staff ma no ggee i ediately available for review. A new applicati may be N <br /> submitted when the file Is available. to p 7 <br /> g Any file not returned in the same condition as rete d wil re rnized by EHD staff at the expense o e applicant. , <br /> Future file reviews by the same applicant may re Ire a$125 deposit prior to review, r <br /> -Z i c rouse <br /> s r 5Al eAl' 3 -7 Ai /- crC-� <br /> N <br /> -Received Time—Jul. 3 20 2_11 : 04ANLNo, 0129 7 U-I2 49Q7a73p b <br /> arein NAQ. h�rr �U/ 3y3T siYPo�f KB a,h, <br />