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02/03/2011 14:26 925746F`9 AEI CONSULTANTS PAGE 01/01 <br /> RECEIVED <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> FEB 0 3 2011 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL Crt 600 East Main St. Stockton, CA 95202-3029 <br /> PERMIT/SERVIC ephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/eho <br /> PU�nB'•"-L�!IC RECORDS RELEASE APPLICATION <br /> APPLICANT: wy ltllFP� l+t?N BUSINESSIAGENCY: An CAii4'twriL <br /> ADDRESS: LW I ((LM" CITYISTATEOP: MIhAtk1' 0&�,C4 <br /> PHONE(1): R5)$30-105& PHONE(2): 461b NI <br /> Z) <br /> FACSIMILE: )' �ItfJ <br /> TENTAVVE-APPOINTMENTOATE: 4.ZII LUiA Time: <br /> (Please allow 10 business days from data of application submittal.-TerttettYe only-must no eonfimled) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$115 FE (C H HECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 11331 lAg <br /> Electronic information: ❑ List[] Map-Description: <br /> FILE ADDRESS END USE ONLY <br /> street Street Name City U <br /> 2. 5 CWTI* Wfuna2 <br /> 3. 0 1 <br /> 4. _ Dnit 3 <br /> S. <br /> g, Unh 4 <br /> 7. <br /> 8. '�- []Units <br /> 9. <br /> 10. UnR6 <br /> Specific Dots Range of information Requested: From to <br /> tv <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILESNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT UDWASTEFACNfYNEHICLE fV /JTHER CLEANUP SITE(NON-LOP) ©FOOD FACILM WASYE TIRE I 11 DERGROUND TANK(MOMTORINGIREMOVAL)O(, [I DOG KENNEL ❑DAIRY t�"r'/� ✓ I-/ <br /> WTALARDOUS WASTE GENERATOIO� Q CHICKEN RANCH ��yJ�'ASTEWATER TREATMENT PLAN L' H- (� <br /> IERED PERMITTED FACRRY7C ❑MOTELIHOTEL L,J✓ PUMPER TRUCKNARD(CHEMICAL TOILETS <br /> TATTOOISODY PIERCING ❑POOLI5PA ❑LAND USE APPLICATION SITES <br /> ❑ 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 /> 1. List uo to ten a dresses In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one rile type MUST be selected. Fax to 1209)4114-0138 or mail to the address Indicated above4 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 flies 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 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$116 deposit prior to review. <br /> 6. If you need further assistance,please contact Diane Martinez,at(209)468-3426. <br /> GEHD USE ONLY In <br /> 1 <br /> /ILII <br /> lXD N-0S N2TNa <br />