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�■ O6i14/2012 14:15 FAX 559 442 5081 KLEINFELDER U001/001 <br />EHD LOG NUMBER <br />■ DATE RECEIVED SAN JOAQUIN COUNTY <br />L I ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />hone: a 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />Telephone: ( 209 ) <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: _77f! 2 � ,;)P �A oK% BUSINESS/AGENCY: le ki -r'c e 701 <br />ADDRESS: �_j C) I= St A r --e-4 CITYISTATE/ZIP: <br />PHONE (1): 1f:�52-- ✓c-77 - 14" 59 PHONE (2): S i - � -7 U� _ FACSIMILE: <br />TENTATIVE` APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal -'Tentative only - must be confirmed) <br />USINESS DAYS <br />!J(/L <br />Unit 4 �L <br />c <br />to <br />Specific Date•Range of Information Requested: From <br />ENVIRONMENTAL HEALTH D PARTMEN7 FILES ; <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYICI.E V ` ICLE <br />El[jFOOD FACILITY WASTE TIRE 2 <br />OTHER CLEANUP SITE (NON LOP) ❑ DAIRY ` �� f/ <br />NDERGROUND TANK (MONrrORINGIREMOVAL)t El DOG KENNEL WASTEWATER TREATMENT PLA13�"• rrlr1 - , JJ <br />>�}IAZARDOUS WASTE GENERATOR � ❑ CHICKEN RANCH ❑ T <br />❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ LAND USEPUMPERTAPPLICATION SITES <br />MICAL TOILETS <br />❑ TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION ) <br />F1 MEDICAL WASTE FACILITY <br />❑ COMPLAINT RECORDS ❑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.ten <br />2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximatelyointments <br />(10) <br />days after receipt of application. The files will be held for a maximum of five business days for review. App <br />should be scheduled accordingly. <br />y EHD staff may not be immediately available for review. Anew application may be <br />3. A file that is actively being worked on b <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 applicant. <br />Future file reviews by the same applicant may require a $125 deposit prior to review. <br />I M�� <br />Received Time Jun <br />3 :11 PM No. 0232*5r <br />!6113, 21 FIV). LV?Ozj 31266zi 9LR-, <br />❑ CHECK BOX TO EXPEDITE REQUEST - $125 FEE (CASH OR CHECK40NLY) REQUEST PROCESSED IN 3 B <br />SIGNATURE OF APPLICANT <br />DAT <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />Street # Street Name <br />City <br />2. <br />/fir c o 14, <br />3 <br />/ 2 A.. <br />kA �Z) I <br />t!rJ 4. <br />5. <br />%) Q <br />6. <br />(70 <br />-- <br />7. <br />8. <br />9. <br />10. <br />!J(/L <br />Unit 4 �L <br />c <br />to <br />Specific Date•Range of Information Requested: From <br />ENVIRONMENTAL HEALTH D PARTMEN7 FILES ; <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYICI.E V ` ICLE <br />El[jFOOD FACILITY WASTE TIRE 2 <br />OTHER CLEANUP SITE (NON LOP) ❑ DAIRY ` �� f/ <br />NDERGROUND TANK (MONrrORINGIREMOVAL)t El DOG KENNEL WASTEWATER TREATMENT PLA13�"• rrlr1 - , JJ <br />>�}IAZARDOUS WASTE GENERATOR � ❑ CHICKEN RANCH ❑ T <br />❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ LAND USEPUMPERTAPPLICATION SITES <br />MICAL TOILETS <br />❑ TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION ) <br />F1 MEDICAL WASTE FACILITY <br />❑ COMPLAINT RECORDS ❑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.ten <br />2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximatelyointments <br />(10) <br />days after receipt of application. The files will be held for a maximum of five business days for review. App <br />should be scheduled accordingly. <br />y EHD staff may not be immediately available for review. Anew application may be <br />3. A file that is actively being worked on b <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 applicant. <br />Future file reviews by the same applicant may require a $125 deposit prior to review. <br />I M�� <br />Received Time Jun <br />3 :11 PM No. 0232*5r <br />!6113, 21 FIV). LV?Ozj 31266zi 9LR-, <br />