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DF IVSD SAN JOAQUIN COUNTY EHD LOG NUMBER <br />ENVIRONMENTAL HEALTH DEPARTMENT 3-497 <br />APR 2 2 2016 1868 East Hazelton Avenue, Stockton, CA 95205-6232 '3 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />EMIRONMENTALHEAi.` H PUBLIC RECORDS RELEASE APPLICATION Vjly IIA <br />APPLICANT: TAMMY WOODS BUSINESS/AGENCY: TERRACON <br />ADDRESS: <br />PHONE (1) <br />902 INDUSTRIAL WAY <br />CITYISTATE/ZIP: LODI, CA 95240 <br />209-367-3701 PHONE (2): FAX OR E-MAIL: tkwoods@terracon.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 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 I///�)q / (/�)�I DATE 04-13-2016 <br />/.11 L <br />1. List up to ten addresses in the space below. Select the type(s) of files from the list below 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 />Electronic Information: ❑ List ❑ Map — Description: <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILE ADDRESS <br />EHD USE ONLY <br />FILES <br />® UNDERGROUND TANK (UST) <br />Street # <br />Street Name <br />City <br />, <br />3 S. Pacific Avenue Lodi <br />CONSUMER <br />CLEANUP SITE (LOP) <br />® OTHER CLEANUP SITE (NON -LOP) <br />® HAZARDOUS WASTE <br />❑ DAIRY <br />® TIERED PERMITTED FACILITY2 <br />1111 W. Century Blvd Lodi <br />MVW C C0 . <br />® ABOVEGROUND TANK <br />3 <br />^ <br />I / <br />�� wa M <br />'/�,{ <br />VV ��//�� "" �� <br />{tel/(/ V 'l <br />❑ PWS <br />11 1 <br />® UST (MONITORING / REMOVAL) <br />® HAZARDOUS MATERIALS <br />®SPILURELEASE RESPONSE <br />©/WATER QUALITY <br />® SOLID WASTE FACILITY / VEHICLE <br />4 <br />❑ FOOD FACILITY <br />❑ POOL/SPA <br />❑ DAIRY <br />5 <br />^� <br />SITE MITIGATION <br />❑ LAND USE APPLICATION SITES <br />HOUSING <br />❑ SEPTIC PUMPER TRUCK/ <br />6 <br />YARD / CHEMICAL TOILETS <br />WASTEWATER TREATMENT PLANT <br />EaCUPA <br />❑ HOUSING ABATEMENT <br />7 <br />❑ MOTELIHOTEL <br />CUPA - HAZ-MAT <br />CHICKEN RANCH/ DOG KENNEL <br />MEDICAL WASTE FACILITY <br />8 <br />I <br />❑ TATTOO/BODY PIERCING <br />[�(S/OLID WASTE <br />Z WASTE TIRE <br />g <br />® COMPLAINT <br />C] ACCOUNTING <br />® OTHER(PLEASE SPECIFY): <br />WELL AND SEPTIC PERMITS <br />10 <br />Specific Date Range of Information Requested: From <br />to <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br />***BOXED AREA - EHD USE ONLY*** <br />❑ Records provided by Staff -PPR Complete. Staff Name: <br />i <br />oq� <br />