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12/08/2010 17:33 9257466099 AEI CONSULTANTS PAGE 01/01 <br /> DATE REC EHD LOG NUMBER <br /> EGA SAN JOAQUIN COUNTY <br /> R ENVIRONMENTAL HEALTH DEPARTMENT 58 307 1 <br /> DEC 0 9 ZA 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> NMENTALHTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:-CANT: of BUSINESS/AGENCY:_,Ag caf4SuL rS <br /> ADDRESS: gbb InAmw o DMIt CiTY/STATE1ZIP:_b0JA1Lrr 45W,(A 1 � <br /> PHONE(7): --60b PHONE(2): --(U FACSIMILE: (j2g)j_4_i• M <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be contlrmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$115 F E( A H R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSIN SS DAY$ <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: [] List❑Ma;—D scrlptlon: <br /> FILE ADDRESS EHD USE ONLY <br /> Streetlfgy�pp,,__ Street Name City unit <br /> F-21. �......,._ TnIt 2 <br /> 3. <br /> 4. a� nit3 <br /> 7. <br /> 8. 3 <br /> unit 5 <br /> 1 Q. MQxHANAq <br /> �. <br /> nit f <br /> Specific Date Range of information Requastad: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) El HOUSING ABATEMENTLID WASTE FACIUTYNEHICLE <br /> i�OTHER CLEANUP SITE(NON-LOP) El FOOD FACILITY fTWASTE TIRE <br /> NDERGROUND TANK(MONITORING/REMOVAL) El Dor,KENNEL 13IRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH E WASTcwATER TREATMENT PLANT,, <br /> ERED PERMITTED FACILITY ❑MOTEL/HOTEL <br /> ❑PUMPER TRUCKIYARD/CHEMiCAL7OILETS <br /> [❑ ATTOOIBODY PIERCING ❑POOL/SPA LAND USE APPLICATION SITES <br /> MEDICAL ED WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 0,00 AM-6:00FM(EXCLUDING HOLIDAYS <br /> 11. List up to On 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(20914G4-0139 or mall to the addrga9 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 rile not returned In the some 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$116 deposit prior to raview. <br /> 6. If you need further assistance,please contact Diane Martinez,at(209)468-3426- <br /> M0 U F-ONLY <br /> 68-3426.Lwe-UaE-ONLY <br /> EHD 48 09 <br /> 0!27108 <br />