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02/03/2011 14.26 925741--ft AEI CONSULTANTS PAGE 01/01 <br /> RECEIVE <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> FEB 0 3 2011 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTALH�?�TH 600 East Main St. Stockton, CA 95202-3029 <br /> PERMIT/SERVICE9 ephone: (209)468-3420 Fax: (209) 454-0138 Web: WWW.Sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1�I BUSINESSIAGENCY:�A /`ARG t*4__.-_ <br /> ADDRESS: LtW t^1t11A1Lpp CITY/STATE/ZIP: 4JA"tkt d"ICA_.__ - <br /> PHONE(1); /4415)%3b—IbS& PHONE(2): 40(01 FACSIMILE; /11Z)'l%-i d3 <br /> TENTATIVE"APPOINTMENT DATE:_ d Time: <br /> (Please allow 10 business days from date of application submhtal-'Tenteuve only-must De confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST.$115 FEHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> (C H <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street a Street Name City ❑unit 1- <br /> 1. I -- W <br /> 4. unit 3 <br /> S. -.-�_C�:k4t�'Sitlyt[Cl� <br /> fi . -- UnH4 <br /> 7. <br /> 8 _� p Unit 6 <br /> 9. �t <br /> 10. Unit6 <br /> SpeclHc Date Range of Inforrtrotlon Requsated: From t0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ,�.f LID WASTE.fACIUTYNEHICLE <br /> RDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT WA57E TIRE <br /> fjoi <br /> THER CLEANUP SITE(NON-LOP) ©FOOD FACILITY <br /> __, NDERGROUND TANK(MONITORIN(WREMOvAL) ❑DOG KENNEL ❑DAIRY <br /> tQ AZARDOUS WASTE GENERATOR ©CHICKEN RANCH ASTEWATERTREATMENT PLANT <br /> KKIERED PERMITTED FACIUTY ❑MOTELIHOTEL PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TATTOOIBODY PIERCING ❑PODLISPA ❑LAND USE APPLICATION SUES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-6:00PM(ExCLUDING HOLIDAYS) <br /> 1, List u0 tp ten addresses in the space above. Select the type(s)of Ales from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 1209140-0138 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 days after�receip oappill notify the lcation. IThe fl es will be hold for a los exist. An maximum offiv buointment for lew sin business be days fofrrreview. Appointmentsed <br /> y ten should <br /> (10) <br /> should be scheduled accordingly. <br /> 3. A rile 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 Ale is available. <br /> 4, Any Ale not returned in the same condition as released will be reorganized by EHD staff at the expense ai the applicant. <br /> Future Ale 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 12051468-3425. <br /> END USE ONLY <br /> 8!271P9 <br /> RHD 40.06 <br />