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01/11/2011 10:4© 92574G�099 AEI CONSULTANT"- PAGE 01/01 <br /> REGFV J <br /> ' " E SAN EHO LOG NUMBER <br /> JAN 1 1 2011 ENVIRONMENTALTAL HEALTH COUNTY LTH DEPARTMENT <br /> 600 East Main St, Stockton, CA 95202-3029 59193 <br /> ENVIRONMENTALHEATL*phone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: AE( 099&QbfY� <br /> ADDRESS: —VTP—D (kAdltID pi CITYISTATEIZIP:_yJlh4►�IK ( � _ <br /> PHONE(1): �& — pr�� <br /> PHONE(2): (0FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE- l Time: <br /> (Please allow 10 business days from date of application submittal-•Terdadve only•must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$116 FE (CAH HECK ONLY),REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ��II I LdU <br /> Electronic Information: ❑List❑Map—Desoription: <br /> FILL:ADDRESS END USE ONLY <br /> Sheets Street Name Cky <br /> 2'3. 1yV•� _ .... IAI�_..._ _.A'"[a �{ ._ � Unh2 1,21 <br /> 4. <br /> B'UnIt3 <br /> 7. <br /> nit 4 <br /> 9. - _ —.. ❑,Units <br /> 10. <br /> SpacN1C Date Range of Irlformatlon Unit S. <br /> Requested; From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES q <br /> NDERGROUNO7ANK(LIST)CLEANUP SITE(LOP) ❑HOUING SA6ATEMFNT UD WASTE FACILITYNEHIOLE <br /> OTHER CLEANUP SITE(NDN-LOP) ,,A., [I FOOD FACILITYASYE TIRE ^J <br /> �DERGROUND TANK(MONITORINGIREMOVALiv El DOG KENNEL [I DAIRY Lm) / ' <br /> LM AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH 2WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACIUYYk ❑MOTELIHOTEL s PUMPER TRUCKNARDICHEMICAL TOILET$ <br /> TATTOOISDDY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMR RECORDS ARE AVAILABLE FOR RENEW: MONDAY-FRIDAY 8:00 AM-5:00pm(EXCLUDING HOLIDAYS) <br /> 1. List uo t,o teyr-addrasses 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(2091464.0138 ar 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 /> 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 tan(10) <br /> days after receipt of application. The Files will behold 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 prier to review. <br /> S. If you need further assistance,please contact Diane Martinez,at(209)468.3425. <br /> END USE ONLY <br /> 0 I <br /> W <br /> E a b-oa <br /> eizrros <br />