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E"02/17/2014 15:04 FAX 559 442 5081 KLEINFELDER [9j0U1/UU1 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> FEB .ZD1 " Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION ly <br /> Ei J <br /> - <br /> AI CANT: e_ B SINESS/AGENCY: <br /> :Z 19 /V / A-2(,/ , /< jn :Ce Id 10 ft <br /> ADDRESS: '51 2. �T /V. CITY/STATE/ZIP: F <br /> " _r <br /> &o(F_ /­)Q 2_?-77_Z_ <br /> PHONE(1): PHONE(2): FACSIMILE: <Cj 4YIY2 <br /> TENTATIVE*APPOINTMENT DATE: Time: z <br /> (Please allow 10 business days from date of applichti6n submittal-*Tentative only-must be confirmed) <br /> (CHECKBOX TO' EXPEDITE REQUEST $125 FEE(CASH OR CHECK ONLY -REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> rElectronic Information: [D List 0-Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Y' Street# Street Name City El Unit 1 <br /> r1. <br /> c�_q�4j54�j0-t ❑Unit 2 Y7a. 4ja <br /> 67 '6�)6Zf EfIl j;)(1h 5�� C I I t 3 <br /> *5. 2 <br /> 9A, Dtrnit4 <br /> 4 <br /> J_ 141 W 40AI-P A)C,-CC,--fEl Unit 5 <br /> 9. a�,�3 <br /> 4P 1H�Ip <br /> 1 Unit 6 <br /> 'VpV010 A&;)r (11-E EV-1:r,1$1 w-)er- Mt 6t <br /> U, Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> M11NDERGROuND TANK(UST)CLEANUP SITE(LOP) E]MEDICAL WASTE FAcILTTY ❑SOLID WASTE FACILTTYNEHICLE <br /> 1EIR CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> �ERGROUNO <br /> TANK(MONfTORING/REMOVAL) El FOOD FACILITY ❑DAIRY <br /> [:]CHICKEN RANCH/DOG KENNEL <br /> YEGROUND TANK WASTEWATER TREATMENT PLANT ZA <br /> Ely <br /> Ic =RDOUS WASTEIHA7ARpous MATERIALS Ej MOTEL/HOTEL [:]PUMPER TRUCKNARDICHEMICAL TOILETS 7v- <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> TATTOO/BODY PIERCING ❑COMPLAINTIRESPONsE RECORDS Q 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 /> 4- 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> C 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 appl,!Can t <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> .............. ........ <br /> ............ <br /> 7 t, <br /> Pm'1' 5 IRFM <br /> ........... <br /> gig 14 <br /> .............. .........- <br /> PM4AJ"c4_ cx> 6.1c cherr <br /> ro1106 *#1% 41,0 Q111 14P-,q&Ar �7, 114 <br /> f:b,- Li o e We,tedob-ANded Lf v3F uvAl-IDO +0 "r0aUe,5;-f (%4-fPW- 015�T fr)e yb <br />