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From:Kleinfelder 209 575 3444 07107 X011 12:4? =1`.'C P.UL1 0'�1 <br /> RECEIVED I%'" `"W <br /> DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUI✓BER <br /> jut-0 7 2011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton CA 95202-3029 <br /> ENVIRONMENTAL HEALTH <br /> Telephone: (209) 468-342 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Ak<A BUSINESS/AGENCY:---��� (( j6q(— <br /> ADDRESS: /aa�( V ' 3voe� CITY/STATE/ZIP: * rjtc�pS{t} iCIA <br /> PHONE (1): -q 3 PHONE(2): FACSIMILE:_ <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from d of application submittal-*Tentative only-must be confirmed) _ <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$122 E (C SH OR CHE ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑List❑ Map- Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 1 <br /> 2' 2 <br /> 3. <br /> 4. <br /> --- - ------ nit 3 <br /> 5. <br /> 6. I <br /> -- -----._-._ J�unit 4 <br /> 7. <br /> ❑Unit 5 <br /> 10 <br /> ❑Unit-6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT F1SOLID WASTE FACILITYNEHICLE <br /> T TER CLEANUP SITE(NON•LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> JN-DERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> l�n ARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA P-L-AVp USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑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. <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 returned in the same condition as released will be reorganized by END staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> EHO USE ONLY <br /> EHD 48.06 <br /> 07129110 <br />