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06/01/2010 09:59 925746(9 AEI CONSULTANTS PAGE 01/01 <br />� DAT(:RECEIVED E=HD LOG NU BE <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> l� l� 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web,www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_<kkll� BUSINESSJAGENCY: f c <br /> ADDRESS: ZSay C d„ti.;,,� CiTY/STATEMP: s,.�.,f C&,q tS9-7 <br /> PHONE(l); r_12S-�y�,. �o�t5 PHONE(2): FACSIMILE: RZS <br /> TE=NTATIVE"APPOINTMENT DATE: Time; <br /> (Please allow 10 business days from date of application submittal-'TenraMm only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Elec#ronfe Information: ❑List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City -0 unit 1 <br /> F2. <br /> O lliSunit 2 <br /> 3. <br /> 4. <br /> 5. nk 3 <br /> 6. <br /> 7. <br /> 8. <br /> 9 ❑unit 5 <br /> 10. <br /> Unit 6 <br /> Specific Date Range of Information Requested: From t to <br /> ENVIRONMENTAL,HEALTH DEPARTMENT FiLES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ROUSING ABATEMENT ip;iouD WASTE FACiLITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LAP) ❑FOOD FACILITY ❑WASTE TIRE <br /> fflUNDERGROUND TANK(MOMTORINWREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCHiIAEi MATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELlHOTEL <br /> p�,,., PUMPER TRUCKIYARDiCHEMICAL ToiLETs <br /> ❑TATTooMmy PIERCING [IPOOLISPA ❑LAND USE:APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RemEw: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HouvAY$ <br /> 1. List UP to ton addresses in the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 1208]4ti4-0738 or mail to the address indi d above_ Address <br /> ranges will not be accepted-for additional assistance with file addresses,Contact the]END. Applications received after <br /> 3.00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant If any END files exist. An appointment for review will be conflrmod 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 FHD staff at the expense of the applicant. <br /> Future fila reviews by the some applicant may require a$115 deposit prior to review. <br /> 5. If you need further assistance,please Contact Diane Martinez,at(209)468-3425. <br /> EN6 USE ONLY <br /> END 48.06 <br /> 827/D9 <br />