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01/11/2011 18:40 925746 AEI CONSULTANTS PAGE 81/01 <br /> REG \/V E <br /> SAN JOAQUIN COUNTY EHp LOG NUMBER <br /> JAN 11 2011 ENVIRONMENTAL HEALTH DEPARTMENT 59193 <br /> 600 East Main St, Stockton, CA 95202-3029 <br /> ENVIRONMENTALHE,�L*phone: (209) 468-3420 Fax: (209) 464.0138 Web: www.sjgov.org/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: -( <br /> ADDRESS: ( lantk(p p( —. CITYISTATEtZIP: WAb1)Ih� C,W� � <br /> PHONE(1); �,e 5)%8t4—IOSB PHONE(2):� J -606 FACSIMILE: f ) 74OR`7' <br /> TENTATIVE'APPOINTMENT DATE: I ?fil,l Time: <br /> WIDOW allow 10 bUninoss days from date of application aubmittel-•Tam dv,only,must he conflnnod) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$116 FE (CA FI HECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Stroet# Street Name Cky <br /> _. w s� <br /> �U age q59 .ATo _ Unit2 II�, <br /> 3. - <br /> 4. <br /> --Jd'Unk3 <br /> T. nit <br /> 9. <br /> - _13 Ualt 6 <br /> _ <br /> 10. <br /> Unit 6 <br /> SPOCHIC Date Range of Idformation Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILea <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENTUD WASTE FACILTTYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> OE <br /> DERGROUNo TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> AZAROOUS WASTE GENERATOR ❑CHICKEN RANCH ASTEWATER TREATMENT PLANT <br /> IEREO PERMITTED FACILITY ❑MOTEUHOTEL rUMPER TRUCKNARDICHEMICAL TOILETS <br /> TATTOCIDODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> bdx(es). At least one Nle type MUST be selected. F3X to 1209 464.0139 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(to) <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 Nle 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 atthe expense of the applicant. <br /> Future file reviews by the same applicant may require a$116 deposit prior to review. <br /> s. If you need further assistance,please contact Diane Martinez,at(200)468.3425. <br /> EKb use omr <br /> eNote-oe <br /> NZlla9 <br />