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07/03/2012 10:07 FAX 559 442 50$1 KLErNFELDER U002/002 <br /> DATE RECEIVED <br /> 10 SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd VIU <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: L� t I BUSINESS/AGENCY: <br /> ADDRESS: 5[25 9 G-a.+es i�,re_ <br /> i r CITYISTATEIZIP_ YLU <br /> PHONE(1). 65c( 45LQ b�.,o PHONE (2): 55'� LIlLR (l(pZ FACSIMILE: Fn� �`C2 <br /> TENTATIVE*APPOINTMENT DATE: 0 <br /> T <br /> (Please allow 141 business days from data of application submittal- Tentatfira o,I Time: <br /> y-must be confirmed) <br /> ❑ CHECK BOK TO EXPED€TE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 2p <br /> Electronic Information: ❑ List❑ Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> a1. ❑Unit't <br /> 1,-1 t� <br /> 2. t2 u Gr <br /> t a '1 <br /> 3. l �n f hljlr unite <br /> 4. ?4,i2] > rjf1`/ `moi <br /> 5. �., , t� �r ll•�! I L� 001 <br /> 6. <br /> 7. A)f•` G' } .d Unit 4 <br /> 9. <br /> 1 3 % luits <br /> CI <br /> hh Specific Data Range of information Requested: From to <br /> 'f �• ENVIRONMENTAL HEALTH DEPARTMENT'FILES <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP)( ON-LOP) ❑FOOD FACILITY <br /> ) ❑HOUSING ABATEMENT ❑SOLID WASTE FACT NEHI LE <br /> OTHER CLEANUP SITE N ❑WASTE TIRE j P J �+" <br /> Cn <br /> rQ—I CSNDERGROUND TANK(MoNITORINGIREMOVAL)o- ❑DoG KENNEL El DAIRY �,,3 <br /> CT KA7_ARDOUS WASTE GENERATOR � ❑CHICKEN RANCH ❑/ WASTEWATER TREA WNT PLANT.I <br /> � ❑TIERED lye PERMITTED FACILITY <br /> MOTELIHOTEL ❑PUMPER TRUCK/YARDICHEIACAL TOILETS <br /> T DICAL WASTE FACILITY Y PIERCING <br /> MEDICAL W ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> y.- <br /> 2COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> U WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RE:vIEw. MONDAY-FRIDAY$:00 AM-5:00pm(ExCLUDING HOLIDAYS)� 1 <br /> 1 H 1. List U to ten addresses in the space above. Select the type(s)of files from the list above b checking the a <br /> � box(es), At least one Fie tYp ( ) y g appropriate II$ <br /> type MUST be selected. Fax to 209 4640138 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 <br /> - days after receipt of application. The files will be held for a maximum of five business da s for rev€ew. Appoinme ten(10) <br /> t4) should be scheduled accordingly. Y Appointments <br /> y 3. A file that Is actively being worked on by EHD staff may vo I <br /> � ediately available for review. A new application may be ' <br /> submitted when the file Is available. �j� M1Any file not returned in the same condition as rele ed wil re rganized by EHD staff at the expense o the applicant. <br /> Future file reviews by the same applicant may re €re a$125 deposit prior to review. <br /> `1_L o <br /> Lf <br /> ERecei_ued 1 ime—Jul. 20J2_11 : 04ANLNe, 0129 7 it-IZ= LS 3 <br /> wrz i n4AL h <br /> ai�w� <br />