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12/08/2010 17:33 92574660493 AEI CONSULTANTS PAGE 01/01 <br /> DATE REC - EHD LOCO NUMBER SAN �IOAQUIN COUNTY <br /> R ENVIRONMENTAL HEALTH DEPARTMENT 3- <br /> 4�� a 9 2Q10 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0938 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_ 1 0I � BUS[NESS1AGENCY: r45QL-2ff< <br /> ADDRESS: bU GAMIN 0 DiNLO_.._ - CITYISTATE2IP: ]N �0j '1445M <br /> PHONE(1}: — PHONE(2): —Pq FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: FlW&I o Time: <br /> (Please allow 10 bualA SS days from data of application submittal-'Tenfafive only-must be confirmed) <br /> ❑CHECK 60X TO EXPEDITE REQUEST-$115 F E( A H R CHECK ONLY)•REQUEST PROCESSED 1N 3 BUSIN 55 DAY$ <br /> SIGNATURE OF APPLICANT DATE Ib <br /> Electronic Info rmatlon: C1 List❑Map—D scriptlon: <br /> FILE ADDRESS EHD USE ONLY <br /> Stre9t 4 Street Name City Unit 1 <br /> 3. <br /> a. 03 /} <br /> 5 r nit 9 <br /> nit 4' <br /> 7. <br /> s. 3 <br /> unit <br /> nit e <br /> Spepl(ic Date Range of Information Raquestad: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Iff <br /> NOERGROIINO TANK(UST}CLEANUP SITE(LOP) ❑HOUSING ABATEMENT LFD WASTE FACILITYNEHICLE <br /> E OTHER CLEANUP SITE(NON-LOP) []FOOD FACILITY [WASTE TIRE <br /> NOERGRgUNO TANK(MOMTORINGIREMOVAL) ❑DOG KENNEL ❑ 1RY <br /> AIARDOUS WASTE GENERATtSR ❑CHICKEN RANCH &WASTEWATER TREATMENT PLANT <br /> [YTIERED PERMITTED FACILITY ❑MOTEUMOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑ ATT0018QDY PIERCING POOL/SPA LAND USE APPLICATION SITES <br /> [►MEDICAL E] El WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY$;00 AM-15:OOPM(EXCLUDING HOLIDAYS <br /> 1. Gist un to left a_d-dM$8es In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(05). At least one file type MUST be selected. Fax to '20,191461-0138 d ass 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 reeefpt 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 actfveTy being worked an by EHD staff may not be Irnmedlately available for review. A new application may be <br /> submitted when the file i9 available. <br /> 4. Any file not returned In the sante condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future Me reviews by the same applicant may require a$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)458-3425- <br /> $MDIlSE-ONLY <br /> EHD 16"o <br /> 6lY7F08 <br /> r I <br />