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'j 04/23/2015 13:59 9257466 AEICONSULTANTS PAGE 01/01 <br />I <br />1�pAd�+Ri� EHD LOG NUMBER <br />� ED SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />APR 2 3 2Q15 . <br />1868 fast Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd \\ <br />ENVIROMITISERVIC S <br />PLTFt <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Jordan Vida <br />BUSINESSIAGENCY: AEI Consultants <br />ADDRESS: 2500 Camino Diablo CITY/STATE/ZIP: Walnut Creek, CA <br />PHONE (1): 925-746.6023 PHONE (2): <br />FACSIMILE: 925-748-6099 <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 BOX TO EXPEDITE REQUEST $13�OR CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE -� I S <br />Electronic Information: ❑ List ❑ Map — Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />- Unit 1 <br />Street 0 <br />Street Name <br />City <br />1. <br />2. <br />11180 <br />Vallejo Court <br />French Camp <br />Q 5 t✓ 5 <br />Ih++t IAiZ- J.,CC ❑ Unit 2 <br />.. <br />__. <br />3. <br />.. <br />.[]Unit 3_ <br />4. <br />dunR4 <br />_7' <br />��tt� ❑Unit5 <br />8. <br />— <br />9. <br />i <br />Unit 6 <br />10, <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />® UNDERGROUND TANK (UST) CLEANUP SITE(LOP) ❑ MEDICALWASTE FACILITY ® SOLID WASTE FACILITYIVEHICLE <br />® OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT <br />®WASTE TIRE <br />® UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ FOOD FACILITY ❑ DAIRY <br />® ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />®HAZARDOUS WASTEIHAZARDOU$MATERIALS ❑MOTELMOTEL❑PUMPER TRUCKIYARDICHEMICALTOILETS <br />® TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ TATTooIBOoY PIERCING ❑ COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM -5:00M (EXCLUDING HOLIDAYS) <br />1. t.lst 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 (208) 464-0138 or mail to the address Indicated above Address <br />ranges will not be accepted. Applications received after 3:00 pm will be processed the next business day. <br />2. For assletanca 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 applicatlon. The flies 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 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 $125 deposit prior to review. "`B_OXED AREA. EHD USE ONLY'"'°' <br />4aa 4a1 t i ha i `ro y Le ' (LA LCw 16 1[0 <br />i ro%;aa '�Si Fl c 1448c7 tlK44e'0 Ct- ite GG, <br />0 Records provided by Staff -PPR Complete. Staff Name: <br />T'i _A' r 9R 1-FPAr-Nn RFRn <br />