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07/03/2012 10:07 FAX. 559 442 5M.,t KLEINFELDER iM002/002 <br /> DATE RECEIVED SAN JOAQUIN COUNTY `1 EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 g <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www,sjgov.org/ehd ' <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ckt il. as BUSINESS/AGENCY;_ Lo n-W- Y` <br /> ADDRESS: rj l26 R GA.' S Awe- CITY/STATEOP: �y&YbO, CA g310, <br /> PHONE(1): 654( 4XI? 61W PHONE(2): 65Pt RII.Q ILCoZ FACSIMILE: 65cl 4Z5qFr1 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please afiow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINE S DAYS <br /> SIGNATURE OF APPLICANT DATE -a q1 Z0 <br /> Electronic Information: ❑ List❑Map-Description: <br /> FiLE ADDRESS END USE ONLY <br /> streets Street Name City El Ift <br /> 2. /Of�3. � (714. `; 6 Ai r4*_ LO �oJ6• <br /> 9. <br /> 10. Units <br /> Specific Date Range of infm7muon Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> QQ Umx RGRoouND TAwc(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEf§iENT ❑SOUD WASTE FAt3LITYNEHK:LE <br /> OTHER CLEANUP SITE(NON-LOP) ❑Fow FACiLRY ❑WASTE TIRE <br /> t1NDERGR0UN0 TANK(MmrrORiNGIREMOVAL) ❑DOG KENNEL ❑DAiRY <br /> �AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH 0 WASTEWATER TREATmw PLANT <br /> ❑TIERED PER>urrED FAam ❑MOTELIHOTEL PUMPER TRUCKNAIDH:OMCAL TOIU U <br /> ❑TATTOoll3m PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SiTES <br /> ❑ MEDICAL WASTE FACILITY ®'COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOUDAY6) <br /> 1, List ug to ten addrasses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one fib type MUST be selected. Fax to(20914640138 or mall to the address Indicated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications recelved 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 wil l be confirmed approximately ten(10) <br /> days after receipt of application. The flies will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A fife 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. <br /> EHD USE(,NLY <br /> Received Time—Jul. 3. -2012-11 ; 04A1-No• 0129 <br />