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i■ 10/02/2012 10:16 92574662 AEI CONSULTANTS PAGE 01/01 <br /> I <br /> E RECEIVSD VED EHD LOG NUMBER <br /> DATSAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> QI✓"I .s Nllephone: (209)468-3420 Fax. (209)464-0138 Web:www.sjgov.org/c:hd <br /> IsN PERWISE"V G t=CH <br /> <\\,) <br /> PUBLIC <br /> RECORDS RELEASE APPLICATION <br /> APPLICANT:, �I/� u�rLVtl BUSINESS/AGENCY; F-1 C� Ul �_ S <br /> ADDRESS: L l �_(I'��{2l� 1-��a�{b GITYISTATEIZIP: ��ll}LC _ Z{ <br /> PHONE(1): q j Lj(I) PHONE(2): FACSIMILE: q25 Lt(Q C)lC, <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from data of application submittal-*Tentat/ve 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_ ( ll 2 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> _ FILE ADDRESS EHO USE ONLY <br /> Street of Street Name City 0 Unit 1__ <br /> - ` / f <br /> 2. . ", ."y-41 CGU"l�d O Unit2 <br /> 3. <br /> _ <br /> 4 �I I �� �2� El Unit 3 <br /> 5- IF��1��rcwrJ�a�� <br /> 6. Unit d <br /> 7. <br /> L] Unit 5 <br /> 9. <br /> 10. © Unit 6 <br /> Spaciflc Data Range of Information Requested; From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDFRGROUND TANK(UST)CLEANUP SITE(LOP) 3a HOUSING ABATEMENT SOLID WASTE FACIL TYNF•HICLE <br /> tTOTHFR CI.FANUP SITE(NON-LOP) FOOD FACILITY WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) DOG KENNEL DAIRY <br /> A7,ARDOUS WASTE GENERATOR CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY MOTCLIHOTEL PUMPER (RUCKIYARDICHFMICAL TOILETS <br /> ATTOOIBODY PIERCING POOLISPA LAND USL.APPLICATION SITES <br /> [!iMEDICAL WASTE FACILITY 1COMPI-AnT RECORDS OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to Oen A4resses 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 toI ss Indl:cated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 prn 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 flies 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 lama 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 $125 deposit prior to review. .� <br /> Elio USC ONLY <br /> EHD 48-06 6fi/11� <br /> Received Time Oct. 2. 2012 10: 19AM No. 1277 <br />