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02/03/2011 14;26 <br />RECEIVED <br />DATE RECEIVED <br />EEB 0 3 2011 <br />ENVIRONMENTAL <br />PERMIT/SERVI <br />W <br />-A <br />APPLICANT: <br />ADDRESS: <br />PHONE (1): <br />'57468 9 <br />AEI CONSULTANTS <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main St. Stockton, CA 95202-3029 <br />PAGE 01/01 <br />EHD LOG NUMBER <br />W� <br />a <br />(209) 468-3420 Fax: (209) 464-0138 Web: WWW.Sjgov.org/ehd <br />UBLIC RECORDS RELEASE APPLICATION <br />Imo( T: a_- BUSINESSIAGENCY:CQgkwsm <br />f*$(,Q CITY/STATE/ZIP: Wft,,jtkf , Y <br />PHONE (2): 4d(o I FACSIMILE: / 1YJ)L4-4l I.s <br />ITIVE" APPOINTMENT DATE: Time: <br />(Please allow 1 business days from date of application submittal -'Tentative only - must be confirmed) <br />❑ CHECK BOX TO EXPE ITE REQUEST - $115 FE {CAH HECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLIC NT 1W DATE 3 U <br />Electronic lnfon-nation: List ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />U t <br />F4. <br />Street 0 <br />Street Name <br />WAM <br />City <br />Unit 2 <br />_._ <br />1dJ , �6 C W(`� Unit 3 <br />JJ Unit 4 <br />❑ Unit 6 <br />i <br />units <br />7. <br />_ <br />B.-« <br />9. <br />IL <br />Specific Date Range of Informatio <br />NDERGROUND TANK (UST) CLEA <br />OTHER CLEANUP SITE (NON -LOP) <br />DERGROUND TANK (MONITORIN <br />FTATTOOISODY <br />ZARDOUS WASTE GENERATOR! <br />TIERED PERMITTED FACIUTO(,� <br />PIERCING <br />❑ MEDICAL WASTE FACILITY <br />WELL AND SEPTIC PERMIT RE <br />1. List Uri -to W(1--a1ftsses in <br />box(es). At least one file ty <br />ranges will not be accepted <br />3:00 pm will be processed t <br />2. The EHD will notify the appl <br />days after receipt of applici <br />should be scheduled accor <br />Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />IP SITE (LOP) ❑ HOUSING ABATEMENT LID WASTF. FACILITYNEHICLE !� <br />❑ FOOD FACILITY 5WASTETiREI) �j t = jy <br />V Z7 <br />REMOVAL( ❑ DOG KENNEL ❑ DAIRY Vw ` ✓ <br />❑ CHICKEN RANCH 09ASTEWATERTREATMENT PLANT <br />❑ MOTELIHOTEL PUMPER TRUCKNARDiCHEMICAL TOILETS <br />❑ POOUSPA ❑ LAND U5E APPLICATION SITES <br />❑ OTHER (PLEASE SPECiFY) <br />ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00RM (EXCLUDING HOLIDA <br />e space above. Select the type(s) of files from the list above by checking the appropriate <br />i MUST be selected. Fax to (209) 464.0138 or mail to the address indicated above, Address <br />for additional assistance with file addresses, contact the EHD. Applications received after <br />i next business day. <br />ant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) <br />on. The files will be held for a maximum of five business days for review. Appointments <br />3. A rile that isactively being orked on by EHD staff may not be Immediately available for review. A new application may be <br />submitted when the file is a allable. <br />4. Any file not returned In theame condition as released will be reorganized by EHD staff at the expense of the applicant. <br />Future file reviews by the s me applicant may require a $116 deposit prior to review. <br />6. If you need further assistan e, please contact Diane Martinez, at (209) 468-3426. <br />END tJSE ONLY <br />EHD 48.09 <br />/ JTOM <br />MI <br />MS ...u� Kim <br />i <br />of 9I IVV <br />