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LOG NUMBER <br /> DATE RECEIVED ✓ SAN JOAQUIN COUNTY EHD HD <br /> RECEIVEDENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> JAN 2 IThone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> EWRONMENTALHEA&BLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: "WWWOODS BUSINESS/AGENCY: NOA/TERRACON <br /> ADDRESS: 902 INDUSTRIAL WAY CITY/STATE/ZIP:—LODI, CA 95240 <br /> PHONE(1): 209-367-3701 _ PHONE(2): FACSIMILE:-209-333-8303 <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 TKWOODSOTERRACON.COM DATE 01/21/2016 <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> ^n <br /> Street# Street Name City Co <br /> 1. 2510 I North California Street I Stockton UST, NOCW 49P5 <br /> io <br /> 2. 2102 j North California Street tj, WNS 1 <br /> LLrA <br /> y, <br /> T <br /> 1800 North California Street 523 E Harding O/M. <br /> 1 No I t2H <br /> =J S. 1506 I North California Street NO Nb) AID cd(s 0��4 ,^II <br /> 6• 1546 North California Street NO l, 941it 3 E)u6l <br /> 7. 49 I West Yokuts I A10 aWA Unw f ,d t(f/ nit4 <br /> B. 3132 West March Lane 0 [Q/�J SITE MITIGATION <br /> 9. 424 Maple Street AIO N�`o <br /> 10. 430 Maple Street ( 0 AJo SP N<It s <br /> Specific Data Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> F1 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ��rSOLID WASTE FACILITYNEHICLE <br /> 21 OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT YJ WASTE TIRE :.yG�O �r 6W IN �'� <br /> Q UNDERGROUND TANK(MONnORINGIREMOVALie- E]FOOD FACILITY DAIRY / 1- Z8-r6 <br /> Q ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> ❑HAZARDOUS WASTEIHAZARDOUS MATERIALS OC ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITYok ❑POOUSPA Z LAND USE APPLICATION SITFC <br /> ❑TATTOO/BODY PIERCING COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY)Well and Septic <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 mall 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. ***BOXED AREA-EHD USE ONLY*** <br /> -at _I b,. Lo O- r - i g m; <br /> r o xYJO ku fo,17 i <br /> e <br /> EHD 46-06 711115 <br />