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10/30/2013 11:37 9257466099 <br />AEI CONSULTANTS• <br />DATE RECEIVED SAN JOAQUIN COUNTY <br />830ina3biblv183d ENVIRONMENTAL HEALTH DEPARTMENT <br />H1-IV3H1V1N3INN0bVdQ 1868 East Hazelton Avenue, Stockton. CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.rjgov.org/ehd <br />PAGE 01/01 <br />EHD LOG NUMBER <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPuCANT:GA'�VNBUSINESS/AGENCY: � <br />ADDRESS: `q%r,�0 CA �x�J� CITYISTATEIZIP:I/JALi![/t �� �R CAI <br />PHONE(1): L�S-�%�G- QI(� PHONE(2): 65� 7J 1543 FACSIMILE:GI'�s60q <br />TENTATIVE* APPOINTMENT DATE (�cf fe(r <br />�� Time: <br />(Please allow 10 business days from dale of application submittal -'Tents[/ve Doty. •must be conflrme ) <br />❑ CHECK BOX TO EXPEDITE REQ E'T $125 FEE (CASH OR CHECK ONLY) • REQUEST PROCESSED IN 3 BUSINESS DAYS <br />(( <br />SIGNATURE OF APPLICANT DATE A2 13D +,3_ � � <br />Electronic Information: ❑ List ❑ Map- Description: <br />EHD USE ONLY <br />FILE ADDRESS <br />Sheet# <br />Street Name City - Unit1 I� <br />N�c kion U`l` rhN dla CD <br />2. <br />3. Unit 3 <br />4. <br />5. <br />nit 4 <br />6, <br />7, <br />Unit 5 <br />B. <br />g' nit 6 <br />10. ' <br />Speolfic Data Range of Information Requestad: From <br />1 o btF. _. <br />�� ENVIRONMENTAL HEALTHE EPARTME T FILES SOUDWA$TEFACILITYNEHIC E /I n <br />U✓ ,UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT p y�A$TE TIRE N �PS ��"") -S <br />•� [HER CLEANUP SITE (NON -LOP) // ❑ FOOD FACILITY I� 3 � j/ - <br />E] <br />/_ <br />�tJNDERGROUND TANK (MONtTORINGIREMOVAL) UL, ❑ DOG KENNEL <br />❑r-1 CHICKEN RANCH WASTEWATER TREATMENT PLANT <br />HAZARDOUS WASTE GENERATORS L]MOTELIHOTEL ❑ PUMPFRTRUCKMARDICHEMICAL TOILETS <br />TIERED PERMnTED FACRtTY oL rj POOLISPA ❑ LAND USE APPLICATION SITE$ <br />p TATTOOIBODY PIERCING rGJ OTHER (PLEASE SPECIFY) <br />❑ MEDICALWASTEFACILITY FOR REVIEW: MOS ❑ <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY•FRIDAY 5:00 AM-S:OOPM (EXCLUDING HOLIDAYS) <br />1, List up to ten addressee In the space above. Select the types) of files from the list above by checking the appropriate <br />rranges)wiAlllt least one fie type MUST selec' not be ac eipted for additional ass stance wKh f>7e addled. Fax 209 Oress o 38 r <br />contact file EHD 11 to a gAp I catdIca�jonsbreelveddafte$$ <br />3:00 pm will be processed the next business day. <br />x1st. An apointment for review 2. The EHD will notify the applicant <br />pcat at if any EHD <br />The fifes wil s held for a maximum of five buss sill be confirmed approxiMatOlytOn (10) <br />s days for review. Appointments <br />days after receipt of application. <br />should be scheduled accordingly. <br />may not hs immediately available for review. Anew application may be <br />3, A file that Is actively being worked on by EHD staff <br />submitted when the file is available. <br />4. Any file not returned In the same condition as roleased will be e reorganized Prior <br />by EHD staff at the expenea of the eppllcant. <br />Future file reviews by the same applicant may require a $125 deposit prior to review - <br />Future �� <br />L.)r1. 1 .'i -u IP �Pfi <br />Received Time—Oct.30. 2 <br />o. 4396 <br />