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� ���® ✓ ° sanfi�o` QUIN COUNTY EHD LOG NUMBER <br /> IRONMENTAL HEALTH DEPARRENT Aqv <br /> MAY 0 12014 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd 9 <br /> ENVIRONMENTAL HEALTH r^ rwxr� 7+3im <br /> PERMIT18ERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Jessica Gonzalez f3goBUSINESSIAGENCY: AEI Consultants <br /> 4Li C 0 5S 4r'+S , CoM <br /> ADDRESS: 2500 Camino Diablo CITY/STATE/ZIP: Walnut Creek, CA 94597 <br /> PHONE(1): 510-688-0981 PHONE(2): 925-746-6050 FACSIMILE:-925-746-6099 <br /> TENTATIVE`APPOINTMENT DATE: Please call Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-=H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT . l 2-� DATE <br /> Electronic Information: ❑ List ❑ ddp-Description: 511 /q- <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 1. 7860 W2st Lane Stockton "Ke"P <br /> 2. 7908 West Lane Stockton *�T a roecc wut 3 I2I Unit 2 <br /> 3. 7�C7 NSD['-Fh �esf �-a ^etJ -(-v c- c r1DP� aocc•,p wuF 3 <br /> 4. -7850 West Lanz S ' uc o sT(Kforel ? unit3 ' <br /> 5. ,� ._. t cosy u..d 3 <br /> 6. <br /> Unk4 <br /> 8. <br /> 1 �� iJilJl� " �1 El Unit 5 <br /> 10. <br /> ,Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) MEDICAL WASTE FACILITY ®SOLID WASTE FACILITYIVEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ®WASTE TIRE tl, <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL) F]FOOD FACILITY [_1 DAIRY <br /> ®ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ®WASTEWATER TREATMENT PLANT ,• <br /> ®HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ®TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List u0 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 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 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$125 deposit prior to review. .BOXED AiREA-EHD USE ONLY <br /> 2-1 i <br /> 'j. 6 /� o . <br /> -01 CJIPW1 <br /> V <br /> L 7 17,5 0 IV We f2t <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-86 914112 <br />