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01/05/2011 15: 49 925746E AEI CONSULTANTS PAGE 01/01 <br /> REEGE VED EHD LOG NUMBER <br /> SAN .10AQUIN COUNTY <br /> SAN p 5 2011 ENVIRONMENTAL WEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www_sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: J�sw clmlr BUSINESS/AGENCY: Ay <br /> ADDRESS: _ -Y06 Gt'Mlmo D CITY/STATE/ZIP: WA-yK�At ,( � <br /> PHONE(1): &�� ,J>fo0(a I PHONE(2): - 403' FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE; 'jam Time: <br /> (Please allow 10 businoss days from date of application submittal-"Tentatfva only-must be confirmed) <br /> ❑CHECK B0X TO EXPEDITE REQUEST-$115 FEEJA <br /> A R K ONLY)-REQUEST PROCESSED IN 3 6USINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street A Street Name City Unit 1 <br /> 2. !J� ( s iOC�Qhj ❑Unit 2 <br /> 4. d� rl►�'flllP( i l✓11'r -- � 0 Unit3 <br /> 5. I. <br /> ...... --- <br /> 6• L .. _.._. Unit4 <br /> -1 _....._..._._.�.- <br /> 7. <br /> L <br /> El Unit 6 <br /> _ <br /> unit s <br /> Specific Date Ranga of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NOERGROUND TANK(UST)CLEANUP SfrE(LOP) ❑HOUSING ABATEMENT9A)STE <br /> LID WASTE FACILITYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑Fool)FACILITY TIRE <br /> UNDERGROUND TANK(MONITORINGIREMO VAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEwATER TREATMENT PLANT <br /> ❑TIERL•D PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑ ATTOOIBODY 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 up to ten 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(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHb. 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 connrmed 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 some applicant may require a$115 deposit prlorto review. <br /> S. If you need further assistance,please contact Diane Martinez,at(209)468.9425. <br /> EHo USE ONLY <br /> EMO 48.06 <br /> ara7�os <br />