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10/22/2010 08:46 9257466F" AEI CONSULTANTS PAGE 01/01 <br /> RM <br /> EHD LOG NUMBER <br /> �rO <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> w-.i Z 2 2010 600 Fest Main St. Stockton, CA 95202-3029 <br /> EN'JIRUNNIEN i HEA P phone:(209)468-3420 Fax, (209)464-0138-Web:www.5jgov. rg/eh <br /> RK T AGES PUBLIC RE D RELEASE AP-PLICAx O <br /> APPLICANT:, �. _ BUSINESSIAGENCY':_A CG¢'�C�,L 1-6 t3 <br /> ADDRESS: 25a) a m I n1 IGLblo CI7YlSTATEI IP: GV�I � ' Cts k Cf r-gLf V4 <br /> PHONE(f): �� (fl-(pQD PHOhiE(2); C ?5 � [ 6�� F,ACSIMILE:,(g2 53 <br /> TENTATIVE'APPOINTMENT DATE: Time. <br /> (Please allow 10 businasa days From date of application submittal-"Terrfafl+re only-must bs confirmed) <br /> ❑CHECK 8OX TO EXPEDITE RE ST-$115 FEE(C $H OR CHECK ONLY)-REQUEST PRQQFSSEi]INS BUSINESS DAYS <br /> SIGNATURE OFAPPLICAN -�. ��- �p4Q;Q � DATE <br /> Electronic Information: ❑List 0 Map–Description: <br /> j FILE ADDRESS END USE ONLY <br /> Street# Street Name City <br /> Unit 1 <br /> l DQ aS firrnl tlnit z <br /> r�Ky 5a <br /> t d' 6a �lV'V� �r�ci1� ICY ► Unita <br /> 5, <br /> II 6 <br /> 7. t - _ -�li►lt4 <br /> 8. <br /> 9. CJ.un�i s <br /> 10, 4-1 <br /> unit a <br /> 5pacifia Dafe Range of Information Raquested] From Lv <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROMD TANK(UST)CLEANUP SITE(LOP_) El Houvw ABATEMENT SQUID WASTE FACILrrYNEHICLE <br /> ®OTHER CLEANUP SITE(NON^LOP) ❑FOOD FACILITY WASTETIRE <br /> UNDERGROUND TANK(MON ITORiNGMEMOVAL) El DOG KENNEL DAIRY <br /> HAZARDOuS WASTE GENERATOR CHICKEN RANCW WASTEWATER TREATMENT PLANT <br /> ®TIERED PERMITTED FACILITY N MOTPLIHOTEL PUMmTkucKIYARDICHENICAL'fOII m <br /> TATTOOIBODY PIERCING D POOLISPA LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REViElw,.MoNDA FRIDAY 8:00 AM-5.00Pirf(EXCLUDING HOLIDAY& <br /> 1. n adftgsgaIn the space agave. Select the types)of files frm the list above by checking the appropriate <br /> boxes). At least one Elle a MUST <br /> be selected. F 09 <br /> . t]'P 40"138.4r rn th ore ice v <br /> abv Address <br /> ranges will not be accepted•for additional assistance with flie addresse$,contact the EHD: Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EMD will notify the applicant If any EHD files exist An'appointment f rreview will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of live business days for review. Appointments <br /> should he scheduled accordingly. <br /> 3. A fife that Is actively being worked on by EI-116 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.reorganize by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(2D9)46 3425. <br /> EHD ll5E ONLY <br /> f <br /> I <br /> END 48- <br /> 8 <br /> )27(09 <br /> I � <br />