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0111111902/17/2014 15:04 FAX 559 442 5081 KLEINFELDER *juui/uui <br /> 00 <br /> ! ( 4 <br /> rDATE RECEIVED • (� / � EHD LOG NUMBER <br /> f SAN JOAQUIN COUNTY , <br /> R�("` � ENVIRONMENTAL HEALTH DEPARTMENT <br /> ` f- 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> FEB 2�1p Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> CIVv 1 <br /> APPMANT��,,TR\f <br /> P. A/ &-a-4 <br /> /7 A P ILI BUSINESSIAGENCY: /< ' Q�yL�P ��e.`L <br /> ADDRESS: �j / Z A/ �'i-a-4 c,r 0;-re. 16 C CITY/STATE/ZIP:F/�C-_S/✓D 9X77 Z <br /> PHONE(1): 55_'?- !;77-N-5? PHONE(2): FACSIMILE: 4./ Z -56�� <br /> TENTATIVE`APPOINTMENT DATE: %', ',.� t��`; / Time: <br /> (Please allow 10 business days from date of appllcktin 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 /> SIG�ATURE OF APPLICANT �( �J —'� i /,i:jy�%v :'i DATE 1 f ii��' - i <br /> Electronic Information: ❑ List❑ Map-Description: <br /> AI FILE ADDRESS EHD USE ONLY <br /> —A <br /> µ Street 0 Street Name City ❑Unit 1 <br /> 1- 495 5 a eR, Ud /Zs/ STm� 5 w 5 u �p <br /> p , <br /> 02. C -jC ` IG, O ; i di I� �1oC-GS ❑unit z <br /> 3. `/ �o GJQt e.t U .r 5T tv Ocsr p <br /> �J 4. `1�9 Q7 µ 4 `�Y) w M AsT-i �Jecc°gyp U"` ' nit 3 <br /> .5. !_Ay JaIt, <br /> np (�.rr-,• h USI�U ����,,,,NOCss�p <br /> 8• �5�7� BRA Pt=_, /\ear h Sl�alft P wcc�p urvit-3 DAJnit4 <br /> S 8. 4169 <br /> t. k ' •+ 07 H uS C.OJ W Nc,(V „x�co'DC❑units <br /> sAlIT 5 (,D,- <br /> b. <br /> aa P <br /> „c.ir. <br /> b� ti t y4 CEJ <br /> 10. ��fj .� L. �.,. a `AI cL..+rK ' Cr,' Unit 6 <br /> �- to Specific Date Range of Information Requested: From to <br /> N ENVIRONMENTAL HEALTH DEPARTMENT FILES ` S <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILTTYNEHICLE IG, F I Ie <br /> ER CLEANUP SrrE(N,ON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE CD <br /> d ERGROUND TANK(MONRORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY LAA'�'J I <br /> _S< VEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT 2 Z4 <br /> F RDOUSWAsTEIHAZAR00u5 MATERIALS ❑MOTEL/HOTEL [-]PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILnY ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> N ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> DO — WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 0% <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list above by checking the appropriate <br /> q51 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 /> 6' 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 ten(10) <br /> Cdays 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 a plicant <br /> C3 s Futu, re file reviews by the same applicant may require a$125 deposit prior to review. <br /> NNO ✓6 �!`t <br /> c-hu.ryl�nd- <br /> C C�66 XW7 ryyF dela 1C1 µIJ 4'I le ,Iyam- - -at (u• F:J ✓.dPd gt0r1 (ev7 r- p cur's'Of 40000 0q1 510 <br /> fo 41v3g wu of dpca Lt to �� /u 21 jot? �fl f r�Quesfi f� t f�o ur�7 fr)e jv (1bli• t1lzlP.r (o01 X13 <br />