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12/08/2010 17: 33 9257466099 AEI CONSULTANTS PAGE 01/01 <br /> 0 <br /> DATE REG r EHD LOG NUMBER <br /> RE .5V SAN JOAQUIN COUNTY <br /> G ENVIRONMENTAL HEALTH DEPARTMENT �j g 1 1 <br /> SEC 0 9 2010 600 East Main St. Stockton, CA 95202-3029 v <br /> Telephone: (209)466-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> NMENTALTH PUBLIC RECORDS RELEASE APPLICATION <br /> E . PQiutE1�4 I;0L1 <br /> APPLICANT: o BUSINESS/AGENCY:— ( C ti54Al At3TS <br /> ADDRESS: Cb GAMIr10 nk4'P� CITYISTATE2IP: yA(�'Cj( Rte' <br /> PHONE (1): Cq }�4b-Eobl PHONE(2):(44G) ?5—(D FACSIMILE: (125)-791--(9q <br /> TENTATIVE"APPOINTMENT DATE: I 2 2210 Time: <br /> (Please allow 10 business days from date of application submittal-'Ten(aeve only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$115 F E VR H R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSIN $5 DAYS <br /> SIGNATURE OF APPLICANT DATE �j�p <br /> Electronic Information: ❑ List❑ Map-D scriptlon: <br /> FILE ADDRESS EHD USE ONLY <br /> Sliest# Street Name City Unit1 <br /> 2. N F <br /> 3. <br /> 4, b3 <br /> S. IJE 5 � E5,No 69/5 <br /> 8. M ,_- i J nit4 <br /> �. Ned)?, NO(0/h <br /> $ 3 r _ UIt � At <br /> .10 <br /> 1 D. <br /> nits <br /> Speolnc Date Range of Information Requested: From to <br /> rTrT�y ENVIRONMENTAL HEALTH DEPARTMENT FILES ��' (({ ( 1 /[-IY! <br /> Ln THEIR <br /> CLEANUP SIT[(LOP) ❑Huusmr A13ATZMENT LID WASTE FRCIUTYNEHICLE / �� '� <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY of STE TIRE te <br /> NOERGROUNO TANK(MONITORING/REMOVAL ❑DOC KENNEL ❑ IRY <br /> WASTE GENERATOU ❑CHICKEN RANCH 9ASTEWATER TREATMENT PLANT1,AZARDOUS <br /> ERED PERNimED FACILITY ❑MOTEUHOTEL ❑PUMPER TRUCKIYARB'CHEMICAL TOILETS <br /> ❑ ATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SRE5 <br /> LPJ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY$;00 AM-6:00PNI(ExCLUDING HOLIDAYS) <br /> 1. List upto On addresses In the space above. Select the type(s)of riles 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 mall 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 ton(1D) <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 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$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468-3426. <br /> END USE ONLY <br /> EHD 4a-0e <br /> OIPTIee <br />