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06/14/2012 14:15 FA% 559 442 5081 KLEINFELDER Q001/001 L" ^� EHD LOG NUMBER DATE RECEIVED SAN JOAQUIN COUNTY Rqw ENVIRONMENTAL HEALTH DEPARTMENT 1700 1868 East Hazelton Avenue, Stockton, CA 95205-6232 /ehd <,I cn �. 11 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgoIf v.org/ehd PUBLIC RECORDS RELEASE APPLICATION APPLICANT: 2 /L c^ r BUSINESS/AGENCY: ADDRESS: / Z'0 O s`t' ✓Z t` e^� CITYISTATEIZIP: 99,3701/ � 3FACSIMILE: 57 -/ PHONE (2): S lt2 PHONE (1): � Time: TENTATIVE` APPOINTMENT DATE: (Please allow 10 business days from date R application submittal -'Tentative only -must be confirmed) ❑ CHECK BOX TO EXPEDITE REQUEST - $125 FEE (CASH OR CHECKONLY) - REQUEST PROCEn ®EIN 3 BUSINESS DAYS TD SIGNATURE OF APPLICANT Electronic information: ❑ List ❑ Map — Description: FILE ADDRESS street # Street Name City G 1. y �4"!!n1 l,j2lSe1Z Co 3 - 0- (4�5 4. 0 d 5- 6. IC100 C C 9. 10 Specific Date'Range of information Requested: From ENVIRNMENTAL HEALTH ID PP ERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT TNBER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL 23iAZARDOUS WASTE GENERATOR C74�1 ❑ CHICKEN RANCH ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ POOLISPA ❑ TATTOOIBODY PIERCING F r-11 riY [:]COMPLAINT RECORDS EHD USE ONI rim w N �J 1 r-1SOLIDWASTE FACIUTYNEHICLE� ❑ WASTE TIRE ❑ DAIRY -Z 1� ❑ WASTEWATER TREATMENT PLA iP- p �J `2" ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS ❑ LAND USE APPLICATION SITES ❑ OTHER (PLEASE SPECIFY) Li MEDICAL WASTE ch r-11 MONDAY-FRIDAY 8:00 AM-S:OOPM (EXCLUDING nvLluAr g) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR of files from the list above by checking the appropriate 1. List R to ten addresses in the space above. Select the type(s) box(es), At least one file type MUST be selected. Fax to 209 464-0138 or mail to the address indicated above. Address ranges will not be accepted - for additional assistance with file addresses, contact the EHD. Applications received after 3:00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. y not be immediately available for review. Anew application may be 3. A file that is actively being worked on by EHD staff ma submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganised by EHD staff at the expense of the applicant. Future fele reviews by the same applicant may require a $125 deposit prior to review. Pia IMU16. r o� q , ?;