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NOV-19-2014 WED 02;21 PM KLEINFELDER FAX N0, 8012613306 P. 02 <br /> i 17 <br /> EHD LOG NUMBER <br /> PATE RECEIVE' 9 204 SAN JOAQUIN COUNTY <br /> 1 ENVIRONMENTAL HEALTH DEPARTMENT p <br /> E,y1R0NMEt4-fALNEALTH 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> PERIVItr1SFRWrA, phone: (209)468-3420 Fax: (209)464-0138 Web. www.slgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSIN ESS/AGENCY:_,sn, FCr eE2 <br /> ADDRESS: _�_ '� oy -b4z _zoo _ CITYISTATE/ZIP: ycr Ga KE G yr / <br /> PHONE(1): PHONE (2): a 7/3. IS6R> FACSIMILE: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑CHECK OOX TO EXIFEDITE REQUEST-S130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT A Pr,,,e DATE-It/ / Z-eJ�2- <br /> Electronic Information: ❑ Llst INMap—Descriptlon: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit 1_ <br /> G <br /> 1. i/5/ Qc ' <br /> 2. p Aj TQ acs .�C! '7^2 Ac r�\ti Unit 2 <br /> z7G �2e TQ•�c <br /> 3• + '�! <br /> 4. Unit 3 <br /> to OQ, ��G <br /> G l unit 4 <br /> 7. l.A2L3-i Q� 7Q.RC <br /> 8• 5 O'S i.Aq GC, C�iD 2AG Unit s <br /> 9. <br /> 10. Unit 6 <br /> Specific Date Range of Information Requested: From <br /> i 5 c/D to c'c- 2l� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES SOLID WASTE FACILI7YNEHICLE <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT WASTE TIRI <br /> ❑ <br /> UNDERGROUND TANK(MONITORING/ItDAIRYEmovAL) ❑FOOD FACILITY ❑ <br /> CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> ABOVEGROUND TANK El <br /> PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ®HAZARDOUS WA5TElHAZAR000S MATERIALS ❑MOT/=LIHOTEL ❑LAND USE APPLICATION SITES <br /> TIERED PERMITTED FACILITY ❑POOLISPA <br /> ❑TATTOo/SOOY PIERCING COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REvmw: MONDAY-FRIDAY 8:00 AM-S:OOPM(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(2091461-0138 or Mail to the address Indic ted above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in Identifying the nature and content of EHD records, please contact EHD at the number noted above. <br /> 3. 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 /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense - D USE O the applicant. <br /> Y <br /> Future file reviews by the same applicant may require a$130 deposit prior to review. ""BOX A EA " <br /> ❑ Records provided by Staff-PPR Complete..Staff Name: 118�aVaa <br /> EHp ae-06 <br /> Received Time Nov. 19, 2014 1 :34PM No- 7594 <br />