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DATE RECEIVED FHn I f1r; Ni innRGR <br />SAN JOAQUIN C$6S8 '°N'>MCv;6 SIOZ '96 'AV quail P;AI;O;� <br />RECEIVE 1 68 ENVIRONMENTALHEALTH DEPARTMENT . 1011111 <br />Hazelton Avenue, Stockton, CA 95205-6232 <br />APR 2 $ 2015 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.orgJehd <br />,r r PUBLIC RECORDS RELEASE APPLICATION <br />ENV .. <br />PERMITISERIiICES Jessica Gonzalez <br />APPLICANT: igonzalezCdaeiconsultants_com BUSINESS/AGENCY: <br />ADDRESS: 2500 Camino Diablo CITYISTATE/ZIP: <br />AEI <br />AEI Consultants <br />Walnut Creek, CA 94597 <br />PHONE (1): 925.746-6050 PHONE (2): FACSIMILE: 925-746-6099 <br />TENTATIVE* APPOINTMENT DATE, Please call Time: <br />(Please allow 10 business days from date of application submittal -'Tentative only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST - $125 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />Electronic Information: ❑ List [] Map -- Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />Unit 1 <br />_015nit 2 <br />P3. <br />5 t # <br />421 <br />Street Name <br />Paddock Place <br />City <br />Lodiunincor orated <br />e 3 <br />Unit 4 <br />4. <br />Unit 5 <br />9. <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FICES <br />® UNDERGROUND TANK (UST) CLMUP SITE (LOP) ® MEDICAL WASTE FACILITY ® SOLID WASTE FACILITYIVEHICLE <br />OTHER CLEANUP SITE (NON -LOP) HOUSING ABATEMENT ® WASTE TIRE <br />® UNDERGROUND TANK (MONITORINGIIiEMOVAL) ❑ FOOD FACILITY ❑ DAIRY <br />® ABOVEGROUND TANK CHICKEN RANCH/ DOG KENNEL ® WASTEWATER TREATMENT PLANT <br />HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTEIIHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />® TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />n TATTOOIBODY PIERCING CJ COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: 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 to (209) 464-0138 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 EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (1 D) <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 />Future file reviews by the same applicant may require a $125 deposit prior to review. riaw'aggggriwao�� <br />---------- <br />rn •1..T —n- en, IF n <br />