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all <br />m From:AEl Consultants 406 559 7601 08/2 0015 13:34 #763 P.001/001 <br />MWATMOEIN/ED 19 EHD LOG NUMBER <br />1i 0 SAN JOAQUIN COUNTY <br />an AN k ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />VI �NT�T e: (209) 468-3420 Fax: (209) 464-0138 Web: �vvvv✓.sjgov.org/ehd <br />PERMiTJSERVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Max Martinez " j I �l ,'`� �;' I, i,'.._ BUSINESSIAGENCY: AEI Consultants <br />ADDRESS: 3880 S. Bascom Avenue CITY/STATE/ZIP:-San Jose, CA 95124 <br />PHONE (1): 408-559-7600 PHONE (2): FACSIMILE: 408-559-7601 <br />Please allow 10 business days from date of application submittal for the records to be available. <br />Staff will contact you to arrange an appointment date and time to review the requested records. <br />❑ CHECK BOX TO EXPEDITE REQUEST - $130 FEE (CASH CjaC K ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />Electronic Information: ❑ List ❑ Map — Description: <br />FILE ADDRESS EHD USE ONLY <br />►G <br />I <br />a <br />- <br />Street # Street Name <br />City ❑ Unit 1 <br />9. <br />.3010 Grant Line Road <br />Tracy <br />" 21 © nit 2 <br />2..� <br />-) <br />: �(/; V' <br />3. <br />4• <br />�w �l ((8S C C ❑ Unit 3 <br />5. <br />iE] Unit 4 <br />6. <br />7. <br />Q�s <br />9. <br />/dun <br />10. <br />Specific Date Range of Information Requested: From All <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />® UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ® MEDICAL WASTE FACILITY <br />® OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT <br />® UNDERGROUND TANK (MONITORING/REMOVAL) ❑ FOOD FACILITY <br />® ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL <br />® HAZARDOUS WASTEIH.A.ZARDOUS MATERIALS ❑ MOTELIHOTEL <br />TIERED PERMT T ED FACILITY ❑ POOLdSPA <br />❑ TATTOO/BODY PIERCING ❑ COMPLAINT/RESPONSE RECORDS <br />79 <br />❑ SOLID WASTE FACILITYNEHICLE <br />❑ WASTE TIRE <br />❑ DAIRY <br />® WASTEWATER TREATMENT PLANT <br />❑ PUMPER TRUCK/YARD/CHEMICAL TOILETS <br />i—i <br />LAND Ia ma <br />SE APP IrarinN CTS <br />u n tin i w• vIn E�.a <br />❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM -5:00P41 (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. Applications received after 3:00 pm will be processed the next business day. <br />2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. <br />3. 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 />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 $125 deposit prior to review. *'BOXED AREA- EHD USE ONLY' <br />N <br />W <br />0 <br />El Records provided a,. <br />Staff -PPR Complete. <br />eceived Tine Auo.20. 2015 2:20PM No.9382 <br />Q I £' m <br />A-7 <br />