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01/05/2011. 15:49 92574.."999 AEI CONSULTANT`— PAGE 01/31 <br /> R EGE RVE SAN EHD LOG NUMBER <br /> .JOAQtJIN BOUNTY <br /> JAIL 0 5 2011 ENVIRONMENTAL HEALTH DEPARTMENT Fj 9 <br /> 7 <br /> 600 East Main St, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209) 464-013$ Web: vvww.sjgov_org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_�l�l�Lc BUSINESS/AGENCY: <br /> ADDRESS: 190il CfiMWO Dv"ja" CITYlSTATEIZIP; <br /> PHONE(1): �g2� ,�{�ofo I PHONE(Z}; FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow i0 buslnoss days from data of app Icatien submittal-'Tarrrarive only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-S"115 FET:(JA? <br /> R K ONLY)-REQUEST PRpCE55ED IN 3 t3VSINE55 DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑Map–Aescription: <br /> FILE ADDRESS EHo U5E ONLY <br /> Street 9 - Street Name City Unit i <br /> z. 2232 f 5 1� S7oc pr<1 ❑UnR z I <br /> 4. unrt3 <br /> 5. <br /> _ ,......... <br /> T. <br /> $' Unit 6 <br /> 9. <br /> Unit B <br /> Spocific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE$ <br /> ,_,.�NDERGROUND TANK(UST)CLEANUP SiTE(LOP) ❑HOUSING ABATEMENT DUO WASTE FACiLITYNEHICLE <br /> LV OTHER CLEANUP SITE(NDN-LOIS) ❑FOOD FACILITY WASTE TiRf <br /> 1j UNDERGROUND TANK(MONITDRINGIREMOVAL) ❑DOG KENNEL ❑OAiRY <br /> afqAZARDOUS WASTE(;ENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTLLiHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑ ATTOOISODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SiTES <br /> 0 MEDiCAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AN[)SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00pM EXCLUDING HOLIDAYS) <br /> 1. List up to ten aftlases in the space above. Select the types)of flies from the list above by checking the appropriate <br /> box(es}. At feast one fife type MUST be selected. Fax Lv(,09l484-0498 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with fife addresses,contact the SHO. Applications received after <br /> 3:0D pm will be processed the next business day. <br /> 2. The EH0 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 behold 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$115 deposit prior to rpvlew. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)488-5425, <br /> fHfl USE ONLY <br /> EMO 46.06 <br /> aravrve <br />