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�■ 06/14/2012 14:15 FAX 559 442 5081 KLEINFELDER U001/001 <br /> r <br /> ■ <br /> �■ EHD LOG NUMBER <br /> ■ DATE RECEIVED j SAN JOAQUIN COUNTY <br /> i /70 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> z, www.sigov.org/ehd <br /> Lr1 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sl9 9 <br /> FiqMMITOMM PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �� /L i�- (1 �/��/�`1 G�K) <br /> BUSINESS/AGENCY: lig //r <br /> ADDRESS: /4-I O F St Xr°,e4 CITYISTATE/ZIP: ISA/ 9370:C <br /> PHONE(1): ? 5-77- lel 5 g PHONE(2): � �,21 Z FACSIMILE: J 59� <br /> TENTATIVE*APPOINTMENT DATE: <br /> Time: <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 PROCESSEDDAT IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> Electronic Information: ❑ List❑ Map-Description: <br /> EHD USE ONLY <br /> FILE ADDRESS <br /> Street# Street Name City 1 <br /> �L 0;60 �� <br /> 1 Ce <br /> 2. �r c 0 <br /> "tOC.�ib ❑Unit 2 <br /> �� �w ; voce t� ' J <br /> 3 2 11`?l U 9 fi n <br /> 1�5 4. A) 0 vc��t a <br /> 5. it4 <br /> dun <br /> 6. 00 <br /> _ <br /> 7. c c :-- i rC ,tiv CJS/a <br /> ❑ <br /> I Unit 5 <br /> 8. <br /> 9. <br /> ❑Unit6 <br /> 10. to <br /> Spectfic Dat 'Range of Information Requested: From j r <br /> ENVIRONMENTAL HEALTH D PAR FILES SOLI=Wz��� <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑ �►.{ <br /> FOOD FACILITY <br /> ❑WASTE TIRE tz_ t 5 <br /> DAIRY L <br /> _140THER CLEANUP SITE(NON-LOP) ❑ ?, <br /> �I 6 <br /> NDERGROUND TANK(MONITORINGIREMOVAL);�� ❑DOG KENNEL ❑❑ <br /> CHICKEN RANCH WASTEWATER TREATMENTFLANT' <br /> jjjWAZARDOUS WASTE GENERATOR(� ❑MOTEL/HOTEL ❑PUMPER TRUCK[YARD/CHEMICAL TOILETS <br /> F1 TIERED PERMITTED FACILITY ❑POOIISPA F1LAND USE APPLICATION SITES <br /> E]TATTOO/BODY PIERCING OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List uo 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 /> 2. The EHD will notify the applicant if any EHD 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 /> 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 retumed in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. r� <br /> I+ <br /> Cf Cf 0 1 Li lei j LL <br /> Received Time Jun, 14, 2012 3: 11PM No. 0232�J -76th, ►IG6, 10131 218)0) LV��z�3'Cf��� �`����' �� <br /> � <br /> X61 L)1 <br />