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ISM <br /> 04/23/2015 13:59 9257465P"" AEICONSULTANTS PAGE 01/01 <br /> m CTAT g 'j r EHG LOG NUM13ER <br /> Z � �� SAN JOAQUIN COUNTY E <br /> CO � <br /> 01� ENVIRONMENTAL HEALTH DEPARTM( <br /> ■ !WR 2, 3 Z 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> I;NV�.RMIT(SERVEC SLTI-( <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:Jordan Vida BUSINESS/AGENCY:AEI Consultants <br /> ADDRESS: 2500 Camino Diablo CITY/STATE/ZIP:Walnut Creek, CA <br /> PHONE (1): 925-746.6023 PHONE (2): FACSIMILE:925-746-6099 <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATES l <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Name _ City ❑Unit 1 <br /> 11180 Vallejo Court French Camp <br /> 2 -- �� <br /> 3. _ ❑Unit 2 <br /> -4 - []Unit 3 <br /> 6. <br /> _ EJUnit 4 <br /> 7. f <br /> Unit 5 <br /> L. <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 FACILI YIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ER WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ®ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ®TIERED PERMITTED FACILITY ❑POOLISPA <br /> [jTATTOOIBOOY PIERCING ❑LAND USE APPLICATION SITES <br /> ❑COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR Ri viEW: MONDAY-FRIDAY 8.00 AM-5:00PM (EXCLUDING HOLIDAYS) <br /> 1. List up 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 o 209 464-p 38 or ma to the addr ss Indicateo above. Address <br /> ranges will not be accepted.Applications recelved after 3:00 pm will be processed the next business day. <br /> 2. For assistance In Identifying the nature and content of EHD records, please contact EHD at the number noted above. <br /> 3. 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 appliCatlon. The flies will be held for a maximum of five business days for review, Appointments <br /> should be scheduled accordingly. <br /> 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a $125 deposit prior to review. —*BOXED AREA-EHD USE ONLY' <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> Received Time-Apr. 21 -2015- 1 .5FR7N0. 8580 �,�„4 <br />