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I I 1�,- '1 SAN JOAQUIN (60bb ' � NYNV90 06 ' tE ' I ' 0 amIII ' PP"a"A" I ;)D � � ;_. <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> QST X01 1868 East Hazelton Avenue, Stockton , CA 95205 6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.Sj90V, Or9/ehd <br /> ENRONMENTAL HEALTI-1 <br /> PERMITfSERVICE9 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Christina Ba BUSINESS/AGENCY: AEI Consultants <br /> ADDRESS: 2500 Camino Diablo CITY/STATE/ZIP: Walnut Creek, CA 94597 <br /> PHONE (1 ): 925.746-6043 PHONE (2): FACSIMILE: 925-746-6099 <br /> TENTATIVE` APPOINTMENT DATE: Please call Time: <br /> (Please allow 10 business days from data of apphcatlon submlttal - 'Tenrad" only - must be ConfTrmod) <br /> ❑ CHECK BOX TO EXPEDITE REQUE - .CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT — _. �^� DATE <br /> Electronic Information : [] List ❑ Map — Det�s�ibn : <br /> FILE ADDRESS EHD USE ONLY _ <br /> Street # Street Name City <br /> Unit 1 <br /> 1 . 7945 North EI Dorado Street Stockton <br /> 2. 8003 North I~I Dorado Street k i Stockton I <br /> 3. 7906 �1 — ,EJ Unit 2 i <br /> North EI Dorado Street Stockton <br /> � � ? �? <br /> 4. 8014 North EI Dorado Street Stockton <br /> $ .. ...- - - .. . 17 Unit 3 <br /> 6. <br /> 9. —BA <br /> ''Unit 5 <br /> 1o. <br /> I Dnit 6 <br /> Spec(go Dat® Range of Information Requested: From ALL To ALL <br /> IID�II ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> bi UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ® MEDICAL WASTE FACILITY ® SOLID WASTE FACIUTYNEHICLE <br /> OTHER CLEANUP SITE (NONmLOP) ® HOUSING ABATEMENT ® WASTE TIRE <br /> ® UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ FOOD FACILITY ❑ DAIRY <br /> ABOVEGROUND TANK f:] CHICKEN RANCH/ DOG KENNEL ® WASTEWATER TREATMENT PLANT <br /> ® HAZARDOUS WASTEIHA2ARDOUS MATERIALS ❑ MOTELIHOTEL PUMPER TRUCHIYARDICHEMICALTOILETS <br /> ® TIERED PERMITTED FACILITY ® POOLISPa <br /> ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY PIERCING ® COMPLAINTIRESPONSE RECORDS - ❑ OTHER (PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 6 :00 AM-5:00PM (EXCLUDING HOLIDAYS) <br /> 1 . List up to ten addresses In the space above. Select the types) of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to (209) 464.0138 ar the <br /> 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 p ocossed the next business day. - <br /> 2. The EHD will notify the applicant If any EHD files exist. An appointment for review will be Confirmod approximately ten (10) <br /> days after receipt of application. The files will be hold 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 appllcanL <br /> Future file reviews by the same applicant may require a $125 deposit prior to review. <br /> : :. - <br /> rl4l I% <br /> id <br /> .. ., , „ . <br /> �■ <br /> BlNt2 -� <br />