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01/11/2011 18:40 925746E AEI CONSULTANTS PAGE 01/01 <br /> RE DELVED <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> JAN 11 2011 ENVIRONMENTAL HEALTH DEPARTMENT 5 9 <br /> 600 East Main St, Stockton, CA 95202-3029 <br /> 193 <br /> ENVIRONMENTALHEITL*PI'one: (209) 468-3420 Fax: (209) 464-0138 Web: wvvw.sjgov.org/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_ 3(J( BUSINESS/AGENCY: <br /> ADDRESS: _�gQD ( tatltip D( _ CITY/STATE/ZIP: <br /> WM-►10tf C,�;� 9�'7 <br /> PHONf:(1): &�b� 0 PHONE(2):� 46(0 FACSIMILE-. I pcj� <br /> TENTATIVE'APPOINTMENT DATE: ( w Time; <br /> (Please allow 10 bYOhtess days from data of epplicatlon aubmiKel-•Tarrtathe only-muat be oonflrmedl <br /> ❑CHECK BOX 70 EXPEDITE REQUEST-$115 FE (CAM HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE I>'ll I L-0U <br /> Electronic Information: ❑List❑Map—Description: <br /> FILE ADDRESS EMD USE ONLY <br /> Street# Street Name city <br /> 23.. $05 .... . . <br /> C _WA_- ...agS l �[o U R2 �I21 <br /> 4. <br /> 7. nit 4 <br /> Unit s <br /> SpacNld Date Range of ITNormatlon Requaeted; From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SRE(LOP) ❑HOUSING ABATEMENTLID WASTE FACILrrYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> tDERGROUND TANK(MONITORINGIREMOVAL) El KENNEL ❑DAIRY <br /> tZARODUS WASTE GENERATOR ❑CHICKEN RANCHASTEWATER TREATMENT PLANT <br /> RED PERMITTED FACILITY ElMOTEL/HOTEL [PUMPER TRUCK/YARDICHEMICALTOILETS <br /> IE <br /> TATTOO/BODY PIERCING ❑PQOUSPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REviEw: MONDAY-FRIDAY 6:00 AM-5t00PM(EXCLUDING HOLIDAYS) <br /> I, List 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(209)484.0138 or 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 ten(10) <br /> days after receipt of application. The files will be held fora 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 /> e. If you need further assistance,please contact Diane Martinez,at(209)468.3425. <br /> E11 <br /> ENDbaEONLY11 <br /> NTlxla <br />