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04/09/2010 09:44 9257400099 AEI CONSULTANT PAGE 01/01 <br /> �I <br /> E� EHD LOG NUMBER <br /> SAN .lOAQUiN COUNTY <br /> e L 110 ENVIRONMENTAL HEALTH DEPARTMENT <br /> APR <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> EWRONMIL( �;� jiiphone: (209)468-3420 Fax. (209)464-0138 Web: www.sjgov.org/ehd <br /> PERMITISERViJES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �i lr>7 BUSINESSIAGENCY: A-E� <br /> ADDRESS: 2J CITY/STATE/ZIP: khm Ll-k- - _ C'k' (A 9�{SGI <br /> PHONE(1): 74 - PHONE(2):_ jd �.D` 1 (o FACSIMILE: Lo �� `� <br /> T;ENTATrV *APPOINTMEN ATE: Time: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$115 F SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT BATE C <br /> Electronic Information: ❑ List Q Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 2. 2 2 N oy+h Wax o Slr'U+ nit 2 � <br /> 3. 2 2 (p _N ori 1 (Y)cu <br /> 'N�, <br /> 4. �,�2 NpY�' f I r nn a,ta(-"+ Lod-1 Unit 3 <br /> s. <br /> 1-20 t L 0 C Ke fcr CA Ar _ -t` Lrd Unit4 <br /> 7. 400 Norl'i <br /> $. N 0 r+1' 1 S CJ1 lfsa ). 9--f'. LU C(.iic r ❑Unit 5 <br /> 9. <br /> 10. nit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) D HOUSING ABATEMENT SOLID WASTE FACII_ITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ®WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) p DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEUHOTEL PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> [gJTATTOo/BODY PIERCING ©POOUSPA LAND USE APPLICATION SITES <br /> ® MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List un to ten add[€_sses in the space above. Select the type(s)of fees from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. a to 2091 4-,0136 gr mall to the adgress indicated above._ Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received aftar <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 file not returned in the same 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$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468-5425. <br /> EHD USE ONLY <br /> EHD 48-06 8!27!09 <br />