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01/05/2011 15:49 92574E'999 AEI CONSULTANT PAGE 01/01 <br />e••p�GC'�Y'vE® EHD LOG NUMBER <br />I VC'�'Y' SAN COUNTY <br />JAN 0 5 2011 ENVIRONMENTALTAL HEALTH DEPARTMENT <br />600 East Main St. Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Sr.:Nu ( c4}A14 BUSINESS/AGENCY: fiNSiALlaff6 <br />r <br />ADDRESS: /)-Yoe OtMIn10 Dv,�" CITY/STATEIZIP: WA-tt4Qr( ,I �fll <br />PHONE (t): (926 i(d0(o I PHONE (2):� )R3a r(9 _ FACSIMILE: ! i'5)'�� D <br />TENTATIVE'APPOINTMENT DATE; SII Time: <br />(Plea is allow 10 businass days from data of Lapplication submittal -'Tentative only- must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST- $115 FEE ( A P. K ONLY) - REQUEST PROCE55ED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT / Me DATE 05 1l <br />M11 <br />Electronic Information: ❑ List ❑ Map — Descnptlon: <br />_ FILE ADDRESS EHD Use ONLY <br />streets Street Name City Uniti <br />1. <br />Z21 <br />�a�. �"+�1,�Tp�I_�......__..........,..St.,�o�?r`� <br />LroI StI�IF' <br />I� i ❑Un1t2 <br />2• <br />z.,l ✓% <br />3.O�cYrrM�=C' <br />D o S. <br />wCi <br />4. <br />0 <br />GAT:EfLUFi'�1i1 =h7't> % <br />5. <br />Un114 <br />s• <br />7. <br />Unit 6 <br />units <br />8.El <br />9. <br />10. <br />Specht Date Range of Information Requested: From to <br />t <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES,_,('OERGROUND TANK (UST) CLEANUP SRE (LOP) ❑ HOUSING ABATEMENT u30LID WASTE FACILITYNEHICLEHER CLEANUP SRE (NON -LOP) ❑ FD00 FACILITY WASTE TIRE�,UERGROUND TANK (MONITORINGIREMOVALO ❑ DOG KENNEL ❑ DAIRY rrJ <br />�V FIPiARDOUS WASTE GENERATOR a ❑CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br />TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKNARDICHEMICAL TOILETS <br />] ATTDOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />ff 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 />I. List up to ten addresses in the space above. Select the type(s) of Nles from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax W f2D914B4-0198 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 />9:00 pm will be processed the next business day. <br />2. The EHO will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) <br />days after recelpt 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 Poe that is actively being worked on by EHO staff may not be Immediately available for review. A new application may be <br />submitted when the Nle is available. <br />4. Any file not returned In the same 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 $115 deposit prior to review. <br />S. If you need further assistance, please contact Diane Martinez, at (209) 488-5425. <br />