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Rv GEEI VE D EHD LOG NUMBER <br />f� SAN .IOAQUIN COUNTY <br />APR 2 0 206 ENVIRONMENTAL HEALTH DEPARTMENT -�E f`' r <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232`1 <br />`�ROtErsF;lphone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />EAlip <br />a� <br />PflE-RV.iTr3ERV1GE8 PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: BUSINESS/AGENCY: Environmental Consultant <br />.40 <br />ADDRESS: 5216 Harwood Road <br />CITYISTATE/ZIP: San Jose, CA 95124 <br />PHONE (1): 831-406-3850 PHONE (2): 408-406-3850 FAX OR E-MAIL: stuart@phase-1environmental.com <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 aDDointment date and time to review the requested records. <br />Digitally signed by Stuart G. Solomon <br />❑ CHECK BOX TO EXPEDITE RE DR OtNE13Ka©NLI** y LC -&T PROCESSED IN 3 BUSINESS DAYS <br />email=stuart@phase-1 envlronmental.com, c=US <br />SIGNATURE OF APPLICANTA4�;Zr4__Date: 2015.04.2012:29:15-07'00' DATE 20 April 2016 <br />E Electronic information: [ List ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />Street # <br />�. Street Name <br />City <br />1 <br />1300 <br />W. Victor Road <br />Lodi <br />^� <br />(' ` �C� <br />El Unit 1 <br />2. <br />3. <br />(Unit 2 <br />4. <br />El Unit 2H <br />5. <br />LUnit 3 <br />6. <br />MA <br />TIE -1 Unit 3HM <br />7. <br />F1 Unit 4 <br />8. <br />SITE MITIGATION <br />9. <br />❑ Unit 5 <br />10. <br />Specific Date Range of Information Requested: From All please <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />U UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MOTELIHOTEL <br />OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT <br />F UNDERGROUND TANK (MONITORING/REMOVAL) ❑ WASTE TIRE <br />F,/ ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL <br />❑ HAZARDOUS WASTE ❑ MEDICAL WASTE FACILITY <br />HAZARDOUS MATERIALS ❑ TATTOO/BODY PIERCING <br />❑ TIERED PERMITTED FACILITY ❑ COMPLAINTIRESPONSE RECORDS <br />to <br />❑ SOLID WASTE FACILITY/VEHICLE <br />❑ FOOD FACILITY <br />❑ DAIRY, POOLISPA <br />❑ WASTEWATER TREATMENT PLANT <br />❑ PUMPER TRUCKIYARD/CHEMICAL TOILETS <br />❑ LAND USE APPLICATION SITES <br />❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 30:00 AM-5:OOPM (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. Applications received 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 application. The files 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 EHD staff at the expense of the applicant. <br />Future file reviews by the same applicant may require a $130 deposit prior to review. <br />***BOXED AREA - EHD USE ONLY*** <br />0 Records provided by Staff -PPR Complete. Staff Name: <br />t <br />U <br />