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r- <br /> 41 <br /> EHD LOG NUMBER <br /> TE�,•R=CEi�YECI cmc, �;�.1 <br /> l SAN JOAQUIN COUNTY <br /> 11 Z11V; ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> t <br /> t I~ti I�t��{( riz�j 11•iF 1I1ep one: (209) 468-3420 Fax: (209) 464-0138 Web: v-JVNi.sjgov.orcqIlehd <br /> t11('j� t !'�,.{lt�1' s si <br /> PUBLIC EGORDS RELEASE APPLICATION <br /> , r , � . , <br /> ,.n <br /> : :7 <br /> 'f ' APPLICANT: Victoria Jordan BUS INESSIAGENCY: Kleinfelder I <br /> ADDRESS: 2001 Arch Airport Rd., Suite 100 CITY/STATE/ZIP: Stacktan,CA 95206 <br /> PHONE (1): (209)469-4375 PHONE(2): (209)948-1345 FACSIMILE: (209)234-4700 `, <br /> TENTATIVEkAPPOINTMENT DATE: Time: <br /> 1p ease alIow'10-bus iness days rom date of ap lication submittal-•Tentative,only-must be confirmer3} <br /> CHE BO PEDITE EQ E S1 .FEE(CASH O�CHECK ONLI) REQUES PT RIOGESSED IIV'3-BUSINESS DAYS <br /> SIGNATURE O APPLICANT 1 DATE I- IV- lel <br /> Electronic Information: ® List❑ Map-Description: I <br /> FILE ADDRESS EFID USE ONLY <br /> Street.#, Street Name I City ❑Unit 1 <br /> r q <br /> 2. f '. .`) . : '1coi r-1Zr'I�rt7 r! ❑Unit 2_ fi <br /> 4. <br /> 6a, ! r � <br /> n.IFS �+�.r3"Z1j�-.'� llnit3 <br /> 5. <br /> 6. (Iof) 1r.it4 <br /> $- f c? YtY j't ! u ✓ G-3-� ❑ Units <br /> 10- L '5 i� aim 01 [ ,h&e O."IT'nit 6 <br /> Specific Date ange of Informatioi- equested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ©UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY X❑SOLID WASTE FACILITYIVEHICLE <br /> ©OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITOWNGIRFMOVAL) ❑FOOD FACILITY [:1 DAIRY <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCH]DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ®HAZARDOL'SUVASTEIHAZARDOUSMATERIALS ❑MOTELIPOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ©TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMilT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:0D AMI-5:00133(EXCLUDING HaLIDAYS) <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. <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 an by l--HD staff may not he immediately available for reviaw. A nev,,application may be <br /> submitted v.hen the file is available. <br /> 4. Any file not retursled in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future fife revievr- by the same applicant may require a$125 deposit priorto review. `-BOXED Af?EA-EI-ID USE ONL•f <br /> Cl Records provicIsd by Stafi-PPR Conlplete. Swanarile: <br /> EHD 48-06 814112 <br />