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12/08/$010 17:33 9257466099 AEI CONSULTANTS <br />DATE RECMje f) SAN JOAQUIN COUNTY <br />REG ENVIRONMENTAL HEALTH DEPARTMENT <br />DE 0 9 2010 600 East Main St. Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />IIENTALHEA H PUBLIC RECORDS RELEASE APPLICATION <br />PAGE 01/01 <br />EHD LOG NUMBER <br />58 307 1 <br />71 rPa, emt l BUSINESSIA6ENCY: � CaNSuCTfiNj_,C <br />(1): EtM14-b-Fool PH( <br />TENTATIVE' APPOINTMENT DATE: <br />(Please allow 10 business days from <br />Time: <br />must be confirmed) <br />IJ'HECK BOX TO EXPEDITE REQUEST -sl15F E (A H R CHECK ONLY) • REQUEST PROCESSED IN 3 SU$IN-$$ DAYS <br />SIGNATURE OF APPLICANT 14DATE <br />Specific }fete Ranye of Information Raqumted: From <br />OUND TANK (UST) CLEANUP SITE (LOP) <br />L] Hcuswr, ABATEMENT <br />a.EHID <br />USE ONLY <br />Unit 1 <br />DUND TANK(MONITORINWREMOYALk <br />❑DOG KENNEL <br />US WASTE GENERATV <br />❑ CHICKEN RANCH <br />iRMITTED FACILITY <br />❑ MOTEIJHOTEL <br />IODY PIERCING <br />❑ POOUSPA <br />I <br />� <br />❑ OTHER (PLEASE SPECIFY) <br />■A <br />'Lr <br />,, r,L s►' <br />t i <br />i <br />0.1 .,�►� <br />a <br />Specific }fete Ranye of Information Raqumted: From <br />OUND TANK (UST) CLEANUP SITE (LOP) <br />L] Hcuswr, ABATEMENT <br />.EANUP SITE(NON-LOP) <br />[I FOOD FACILITY <br />DUND TANK(MONITORINWREMOYALk <br />❑DOG KENNEL <br />US WASTE GENERATV <br />❑ CHICKEN RANCH <br />iRMITTED FACILITY <br />❑ MOTEIJHOTEL <br />IODY PIERCING <br />❑ POOUSPA <br />WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />if �q <br />to�Ifill"fill"LES j�✓ <br />OUD WASTE FACILITYNEHICLE � �% <br />ASTE TIRE Wfyf f :?5 , <br />Q [WASTEWATER TREATMENT PLANT I -L" I" <br />PAIRY <br />'D <br />❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />❑ LAND USE APPLICATION SITES <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY $;00 AM-6:00PM (EACLUDINO HOLIDAYS <br />1. List u0 to ten Addresses In the space above. Select the type(s) of riles from the list above by checking the appropriate <br />box( s). At least one file type MUST be selected. Fax to (208) 464.0136 or mall 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 some 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 $116 deposit prior to review. <br />6. If you need further assistance, please contact Diane Martinez, at (209) 468.3426. <br />