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DATE RECEIVED SANJ4AQUIN (gv9u"Nlm Nd60 :S Zl0I '6l 'A ON allli paAI ;);yR <br /> RECEIVED ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> NOV 12 20ifelephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_ Victor DeTroy BUSINESSIAGENCY: AEI Consultants <br /> ADDRESS: 5933 W. Century Bvld., -Suite 360 CITYISTATEIZIP: Los An, elc�_es, California 90045 <br /> PHONE(1): 310-798-4255 PHONE (2):310-846-6533 _ FACSIMILE: 310-846-5594 <br /> TENT'ATIVE*APPOINTMENT ]DATE Time: <br /> (Please allow 10 buslness days from date of appilcation submittal—Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 EEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINES5 DAYS <br /> SIGNATURE OF APPLICANT DATE Nov 12, 2012 <br /> Electronic Information: [] List❑ Map–Description: <br /> FILE ADDRESS EHO USE ONLY <br /> Streat 4 Street Name City Unit 1 <br /> 1. 11156 McKinley r bI4o French Camp <br /> _2. 11288 McKinley French Camp 0 unit 2 <br /> 3.4. <br /> JUnit 3 <br /> _ ❑ Unita <br /> 7. <br /> Unit 5 <br /> 9. <br /> 10. - - — <br /> (]Unit 6 <br /> Specific Date Range of Information Requested; From Oldest to Newest <br /> ENVIRONMENTAL HEALTH DEPARTMENT rILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SrTE(LOP) ❑MEDICAL WASTE FACILIry ®SOLIR WASTE FACILiTYNEHICLE <br /> OTHER CLEANUP SITE tNON-LOP) ❑HousinG ABATEMENT WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINGIRFMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/000 KENNEL WASTEWATER TREATMENT PLANT <br /> ®HAzARDOUs WASTEIKA2ARDOUS MATERIALS ❑MOTEL/HOTEL ®PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> �3I TIERED PERMITTED FACILITY ❑POOLISPA LAND Usk APPLICATION SITES <br /> ❑TATT001BODY PIERCING ®COMPLAINT/RESPONSE RECORDS ❑07HER(PLEASE SPECIFY <br /> WELL AND SEPTIC PERMIT RECOROS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:Dopm(EXCLUDING HOLIDAYS) <br /> 1. List up to fen 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)464-0139 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 END 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 /> - y applicant may require a$125 deposit prior to review. '"BOXED AREA:.EHD USE ONLY <br /> Future fife reviews h the same a lica _ _ <br /> pen <br /> ■ <br /> T6tO 39Vd SLNV_L- CnSNOO I3d I178Z86L0I8T TV:9L ZTBZ/ZI/II <br />