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enLJ wv rvvmocr. <br /> DATE RECEIVED SAN JOAQUIN CC669 °N WdlO Z tiIOZ LZ 'end aulil pan i aaa� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 1 A: (209) 468-3420 Fax: (209) 461-0138 Web: www.sjgov.org/ehd <br /> Hilt• �, „ PUBLIC RECORDS RELEASE APPLICATION <br /> APPLLCAN�T: Jessica Gonzalez BUSINESS/AGENCY: AEI Consultants <br /> FVIA <br /> ADDREPQRi Lino Diablo CI'T'Y/STATE/ZIP: Walnut Creek, CA 94597 <br /> PHONE (1): 925-746-6060 PHONE (2): 5106880981 FACSIMILE:925-746-6099 <br /> TENTATIVE'APPOINTMENT DATE: Please call Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE{CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List 0,Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City 0 Unit 1 <br /> 1. 141 North EI DoradoStreet Stockton <br /> 2. i 6 15 C9 L1 '�✓yam ZUnit2 <br /> 4. 1 Unit 3 <br /> 5. <br /> U,It 4 <br /> 7, <br /> 173 Unit s <br /> 9. <br /> 10. Unit s <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY 0 SOLID WASTE FACILITYNEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ®WASTE TIRE <br /> �I UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ®A13OVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL Z WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WAsTEIHAZARDOOS MATERIALS ❑MOTEUHOTEL ❑PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> ®TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5i:OOPM(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 /> box(es). At least one file type MUST be selected. Fax to(209)464 0138 or mail tp 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 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 ap�llcant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> I�- <br /> ,•1 e <br /> r <br /> J •• <br /> f' <br /> . •u•;'::,;...3':is:,.: <br /> ,.J <br /> _ f <br /> ill <br /> - 4 <br /> .......... <br /> .: 1 ;:�� i► e14r12 <br /> EHD 48.05 <br />