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0 <br />01/29/2010 16:08 <br />Mn7-7 Ti -'i i <br />9257466099 <br />AEI CONSULTANTS <br />SAN JOAQUIN COUNTY <br />PAGE 01/01 <br />FHb LOG NUMBER <br />ENVIR NMENTAL HEALT DEFARTMEN'T <br />JrJ 10 600 East Main St. Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 FAX* (209) 464-0138 Web: www.sjgov.org/ehd v <br />ENUIkUNI`JiENT NEALTH <br />�ERMIPRVIQE PUBLIC RECORDS RELEASE APPLICATION <br />� �If11 '�PR�� <br />APPLICANT: 0\9, <br />BUSINESSIAGENCY:, Com` q�V <br />ADDRESS: 25-912 <br />PHONE (1) PHONE (2): FACSIMILE: ^moi L4.14- 99 <br />TENTATIVF* APPOINTMENT DATE: ,nme: <br />(Please allow 10 business days from date of application submittal -'Tentative only - must be confirmed) <br />© CHECK BOX TO EXPEDITE REQUEST - $105.00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE pt _ <br />Electronic Information: ❑ List ❑ Map- Description: _4 <br />0 CHICKEN RANCHASTEWATER TREATMENT PLAW <br />Q MOTEL1ft0YE1 PUMPER TRUCKIYARDICHEM TOILETS <br />Street # <br />FILE ADDRESS <br />Streit Name <br />G <br />EHD USE ONLY <br />- d Unit 1 <br />y � �� - <br />it 2 <br />No e� F <br />1. <br />y'z.S o <br />� • Mc�.��.(7 � �� <br />'tea �~�r-�- <br />2. <br />\ <br />3. <br />— <br />Unit 3 <br />r <br />Unit 4 <br />--- <br />T. <br />❑ -Unit 5 <br />Unit 6 <br />10. <br />Specific Date Range of Information Requested: From <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT" FILES <br />DERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HauFANG ABATEMENT QJOUD WASTE FACILrrY1vEHICLP- <br />HER CLEANUP SITE (NON -LOP) 0 Fo00 FACILITY S ASTE?IRE <br />$l'UNDEROROUNa TANK(MOMTORINGJREMOVALO� 0 DOG Kmet-AIRY <br />AZARDOus WASTE GENERATOR VC <br />d TIERED PERmTTED FACILITY <br />0 CHICKEN RANCHASTEWATER TREATMENT PLAW <br />Q MOTEL1ft0YE1 PUMPER TRUCKIYARDICHEM TOILETS <br />❑ TATTO01B00Y Rr-RWNG <br />13POOLISPA 0 LANG UsE APPLICATION SrrEs <br />• MEDICAL WASTE FAciLrry <br />O OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMT RECORDS ARE AVAILABLE FOR;tEvirw - MONDAY -FRIDAY 8:00 Aw5:11OPM - EXCLUDING HOLIDAYS. <br />1. List up to ten addresses in the space above. Select the typo(s) of flies from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to (208) 4640133 or mail to the address Indicated above Address <br />ranges will net 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 />Z. The EHD will notify the applicant If any EHD files exist, An appointment for review will be confirmed approximatefy ton (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 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 vMli be reorganized by EHD staff at the expense of the applicant. <br />Future file reviews by the same applicant may require a $105.00 deposit prior to review, <br />EHD USE ONLY <br />***If u heed further 1stame nlea a contact bion Martinez @a (209)468-3425 directly. Thank You*" <br />G{I U2 Z Z <br />eroaizvaw <br />EHD 40.06 <br />