Laserfiche WebLink
le 10/30/2013 11:37 9257466099 AEI CONSULTANTS PAGE 01/01 <br /> I <br /> ■ '�' � EHD LOG NUMEER� <br /> ■ <br /> DATE RECEIVED SAN jOAQUIN COUNTY <br /> S30IA83SIlIINd3d ENVIRONMENTAL HEALTH DEPARTMENT w <br /> H1ltl3HOm1N3WNOtIWQ 1868 East Hazelton Avenue, Stockton. CA 952050-6 t/ehd `( , <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.$jgov.org/ehd <br /> ctoz 09 110 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> GLS N �t< 13USINESSIAGENCY: <br /> APPLICANT: <br /> ADDRESS: !ice r IA CITYISTATEIZIP:I/J�LfJVrt IHScI� <br /> qrj S_��yG— old PHONE(2): b5� - 5' 3 FACSIMILE- <br /> PHONE(1): 1 �\ Tima: <br /> TENTATIVE'APPOINTMENTOATE: M <br /> (Please allow 10 busmess days from date of apPlfradon submittal 7Tenrar/ve only.must be confirms' <br /> ❑ CHECK BOX TO EXPEDITE REE�jT�S125 FEE(CASH OR CHECK ONLY)•REQUEST PROCESSEDDATE `�J 3D /�2 DAYS <br /> SIGNATURE OF APPLICANT (7 , J <br /> Electronic information: ❑List❑ Map—Description: <br /> ;EHIDUTSEONLY <br /> FILE ADDRESS <br /> Street p Street Name <br /> City unlet <br /> 1. 1a(6tMo Ooh2 <br /> 2. <br /> 3. <br /> nit 3 <br /> 4. <br /> 5. <br /> 4 <br /> 6. <br /> 7. <br /> Unit 5 <br /> 8. <br /> g. nit 6 <br /> 10. = <br /> Specific Data Range Of hdormatlon Requested: From <br /> \ a bIP. to _. <br /> ENVIRONMENTALHNG t-THABA DEPARTME TFlLES �SOUD WASTE FACILITyNEHICSE � 7J <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT <br /> OTHER CLEANUP SITE(NON-LOP) / ❑FOOD FACILITY [IDAIRYl TIRE <br /> KgONDERGROUND TANK(MONITORING/REMOVAL)� ❑DOG KENNEL <br /> CHICKEN RANCH WASTF,WATER TREATMENT PLANT <br /> HAZARDDUS WASTE GENERATORS PUMPERTRUCt(MARDICHEMICAL TOILETS <br /> TIERED PERMiTTEn FACILITY C,4- ❑MOTELIHOTEL ❑ <br /> F1TATTOOIBODY PIERCING OPOOLISPA El LAND USE APPLICATION SITES <br /> ❑ MEDICALWASYE FACILITY <br /> COMPLAINT RECORDS E]OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1, t ist ub to ten addresses In the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2081464-0138 or mall to the address i diol Address <br /> ranges will not be accepted-for additional assistance with fate addresses,contact the EHD. Applications received after <br /> onfirmed 3:00 pm will ba processed the next business day. <br /> 2 days after receipt of applcat ont iThe fl es will be held for a maximum of five bus oasis days for review. Appointments ten(10) <br /> should be scheduled accordingly. <br /> view. Anew application may be <br /> 3. A file that Is actively being worked on by EHD staff may not be immediately available for re <br /> submitted when the file is availe6la. <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff al the expen9e of the applicant <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> D <br /> Received Time—Oct. 30. 2013 11 :41AM NO- 4396 <br />