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10/22/2016 68:46 925746.cr^99 AEI CONSULTANTS PAGE 01/01 <br /> E� SAN OAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> uo' ! Z 2 2010 600 East Main St.Stockton, CA 95202-3029 <br /> EMJ[RUNNIEN HEATT gphone:(209)468-3420 Fax, (209)464-0138 Web:www,Sjgov. rg/eh <br /> PF T� 1Q - P LIC REC R_DS_R EASE-APPYC -- <br /> APPLICANT:---J( _ BUSINESSIAGENCY: � <br /> ADDRESS: 25a) am 1116 ja1210 -JCITYiSTATE/ZiP: G1J. {/� �.APrt � �/�R�$�t <br /> PHONE(1): q� (�-(O0ag PHONE(2): Ca )��(o-(O�rJ� FACSIMILE: (�2 <br /> TENTATIVE*APPOINTMENT DATE: Time.- <br /> (Please allow 10 business days fro-Fd-ate of application sub-lttal-"Tenfafhre only-must bus confirmed) <br /> CJ CHECK BOX TO EXPEDITE RE ST-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLiCAN Sp!aP DATE <br /> Electronic Information: ❑L,ISt❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 14 Unit 1 <br /> TtaKnn <br /> 2. ADDccSfi �ittvy�Cq"1�- ryy <br /> Unit 2 <br /> 3. U S-�` 1-Gf 1'IUU►'li KtM <br /> Unit s <br /> s, <br /> 6. <br /> 7. - unit 4 <br /> 8. <br /> Li unit 5 <br /> .Specific Date Range of Information Requested: From Unit s <br /> 11 <br /> to <br /> ENVIRONMEENTAL HEALTH DEPARTMENT FiLES (� <br /> UNDERGROUND TANK(UST)CLEANUP SiTE(LOP) Q HOUSING ABATEMENT SOLiD WASTE FACILITYNEHICLE �Q , <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE / <br /> UNDERGROUND TANK(MONITORINGIREMOVAL �]DOG KENNET. DAIRY S <br /> HAZARDOUS WASTE GENERATCHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMiiTED FgCILITyo \ MOTUS ,EL PUMPER TRUCKIYARDICHEMICAL TOILETS' <br /> TATTOO/BODY PIERCING v POOUSPA LAND USE APpi cw*N SITES <br /> MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDA -FRIDAY$:00 AM-5:OOPM(EXCLUDING HOLIDAYS <br /> 1. L tit up tQ ten addresses in the space above. Select the type(s)of files farm the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0mall to the dr® s Indicated above Address <br /> ranges will not be accepted-for additional assistance with file addresse#,contact the EHD. Application$received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment r review will be confirmed approximately ten(1 o) <br /> days after receipt of application. The files will be held for a maximum of live 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 reorganize by EHE)staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$115 deposit prio)to review, <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)4683425. <br /> EHD USE ONLY <br /> At + <br /> ' e -o I - Z- <br /> s 1��� <br /> 0 � <br /> EHD 48-06 r2�roa <br /> it?!a1-,i n � f� p_� o- 3 0�Z t/l 4-t(Q-� i AFt P� � �$ W/33- <br /> Ave <br />