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07/19/2011 16:18 4085597601 AEI SAN JOSE PAGE 02/02 <br />rpw <br />T 1 t EHD LOG NUMBER Aft <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />�I f,i 9 201 600 East Main St. Stockton, CA 95202-3029 <br />leph one: (209) 468-3420 Fax: (209) 4640138Web: www,sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Katie Hindt BUSINESS/AGENCY: AEZ Consultants <br />ADDRESS: 3880 S. Bascom Ave, $#108 CITY/STATEIZIP: San Jose, CA 95.24 <br />PHONE(1): 831-295-9725 PHONE (2): FACSIMILE: 408-559-7601 <br />TENTATIVE" APPOINTMENT DATE: Time: <br />(Please allow 10 business days from dela of application submittal-'Tonfallve only - must be confirmed) <br />CHECK BOX TO EXPEDITE E- FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURIEOFAPPLICANT ' $1 khindt@aeiconsultants .COMDATE 7-1.9-11 <br />0�1 <br />Electronic Information: ❑ List [I Map— Description: _ _I <br />10. <br />©unit <br />s <br />Specific Date Range of Information Requastad: From <br />to <br />t <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING A13ATEMENT <br />❑ SOLID WASTE FACILITYNEHICLE <br />d WASTE TIRE <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />UNDERGROUND TANK (MONITORINGIREMOVAL) dL <br />❑ DOG KENNEL <br />[ DAIRY <br />WW GENERATOR <br />Q CHICKEN RANCH <br />❑ WASTEWATER TREATMENT PLANT <br />AZARDOUS ASTE <br />TIERED PERMITTED FACILITY C-- ❑ MOTELIHOTEL ❑ PUMPER TRUCKNARD/CHEMICAL TOILETS <br />❑ TATTOOIBODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br />[:1 MEDICAL WASTE FACILITY El OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5100PM (EXCLUDING HOLIDAYS) <br />1. List un tom addresses in the apace 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, pax to(209) 4640138 or mail to the addresa.Jndicated above._ Address <br />ranges will not be accepted - for additional assistance with file addresses, contact the FH D. 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 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 Zit the expense of the applicant. <br />Future file reviews by the some applicant may require a $122 deposit prior to review_ <br />