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HL(;EF vED <br /> UA It HKtL.GvtU SAN JOAQUIN COUNTY <br /> DEC 19 2016 ENVIRONMENTAL HEALTH DEPARTMENT 5A10 <br /> '1868 East Hazelton Avenue,Stockton,CA 95205-6232 , <br /> BAf1REX1110IN ALHE/NMelephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd yv' <br /> PEt1MITFWA .ES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Hai Ngo/Tammy Sibbitt BUSINESS/AGENCY: Save Mart Supermarket <br /> ADDRESS: 1800 Standiford Ave. CITY/STATE/ZIP: Modesto,CA 96350 <br /> PHONE(1): SRV / • 7.17tj PHONE(2)• OM1 - taa`! FAX OR E-MAIL: <br /> Please allow 10 business days from date o app ication 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 RED T-$130 FEE(CASH-OR K ON REQUEST PROCESSED IN 3 BUSINESS PAYS <br /> SIGNATURE OF APPLICANT 'I 0.nmiwi.`Jr J•� DATE I—A <br /> 1. List up to ten addresses in the space below. Se e t 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$130 deposit prior to review. <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> ENVIRONMENTAL , <br /> HEALTH DEPARTMENT FILE ADDRESS EHD USE ONLY <br /> FILES <br /> ❑UNDERGROUND TPNH(UST) S reef A Street Name City <br /> CLEANUP SITE(LOP) CON$ A <br /> 530 W.Lodi Ave Lodi <br /> ❑OTHER CLEANUP SIZE(NON•LOP) r/1 <br /> ❑HA]NNDWS WASTE ❑DAw. <br /> ❑TIERED PERMITTED FACILITY <br /> ❑ASCV GROUND TANK PWS <br /> ❑UST (MONHNRING/REMOVAL) <br /> 3 <br /> ®HAlARDOUS MATERIALS <br /> ❑SPILURELEASE RESPONSE ❑WATER OaAUTY <br /> ❑SOLID WASTE FACILITY/VEHICLE y <br /> ❑FOOD FACILITY <br /> OPOLL I SPA —� $ITE RK,ATIQY <br /> DIJRY /KAY/k/TV�,} <br /> ❑LAND USE APPLICATION SITES ❑HGuSNG <br /> ❑SEPTIC PUMPER TRUCK/ B <br /> YARD I CHEMICAL TOILETS <br /> CUP\ <br /> ❑WASTEWATER TREATMENT PLANT <br /> ❑HOUSING ABATEMENT I ErrT <br /> ❑MOTEUHOTEL CUPA-RAi?K,VeT <br /> ❑CHICKEN RANCH/DOG KENNEL <br /> B <br /> ❑MEDICAL WASTE FncKrtY <br /> ❑TATTOO/SODY PIERCING ❑So.WASTE <br /> ❑WASTE TIRE 9 <br /> El COMPLAINT <br /> ❑OTMER(PLPASE SPELIHY): ❑ACwvNRNG <br /> 10 <br /> Specific Date Range of Information Requested: From January 1,2016 to Present <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW MONDAY-FRIDAY 8'00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> ---BOXED AREA.EHD USE ONLY"` <br /> Records provided by Staff-PPR Complete. staff Name: <br />