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1 zo DATE RECEIVED EHD LOG NUMBER RECEIVEa HEA SAN JOACOUNTY NVIRONMENTAL HEALTH DEPARTMENT VA 1868 East Hazelton Avenue, Stockton, CA 95205-6232 JAN 2 1T*Ahone: (209) 468-3420 Fax: (209) 464-0138.Web: www.sjgov.org/ehd RECORDS RELEASE APPLICATION APPLICANT: ADDRESS: 902 INDUSTRIAL WAY PHONE (1): 209-367-3701 PHONE BUSINESS/AGENCY: NOA/TERRACON CITY/STATE/ZIP: LODI, CA 95240 FACSIMILE: 209-333-8303 Please allow 10 business days from date of application submittal for the records to be available. Staff will contact you to arrange an appointment date and time to review the requested records. ❑ CHECK BOX TO EXPEDITE REQUEST- $130 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT TKWOODSATERRACON.COM DATE 01/21/2016 Electronic Information: ❑ List ❑ Map — Description: b�f6� Specific Date Range of Information Requested: From to �ENVIRONMENTAL HEALTH DEPARTMENT FILES J1 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY B SOLID WASTE FACILITYIVEHICLE E 71 OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT WASTE TIRE I Jw• 0-4 M' COO /] UNDERGROUND TANK (MONITORINGIREMOVALK El FOOD FACILITY ❑r� DAIRY Ys I- Z $—I /] ABOVEGROUND TANK c: ❑ f'J CHICKEN RANCH/ DOG KENNEL WASTEWATER TREATMENT PLANT /� HAZARDOUS WASTEIHAZARDOUS MATERIALS OL ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS ]TIERED PERMITTED FACIUTYoI ❑ POOLISPA LAND USE APPLICATION SITFR TATTOO/BODY PIERCING ❑ COMPLAINT/RESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) Well and Septic WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464.0138 or mail to the address indicated above. Address ranges will not be accepted. Applications received after 3:00 pm will be processed the next business day. 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. 3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $130 deposit prior to review. ***BOXED AREA- EHD USE ONLY*** FILE ADDRESS aco EHD USE ONLY Street # 2510 2102 Street Name I North California Street I North California Street city I Stockton 1. UST, /UDC44P i 2. 3. 1800 I North California Street I tQ nit2 4• 523 E Harding D Nv It 2H 5. 1506 North California Street A10 A%1 /W d)(5iL�A0 NO M4 -nit 3 6 1546 North California Streetriv 7. 49 I West Yokuts AJO A [in, �db,,UOOIAPEIdlnit4 g, 3132 West March Lane Y,Q/'�' 151,61TE MITIGATION 9• 1 424 Maple Street ,UO oLb. No `•D D Na HJT nns 10. 1 430 I Maple Street b�f6� Specific Date Range of Information Requested: From to �ENVIRONMENTAL HEALTH DEPARTMENT FILES J1 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY B SOLID WASTE FACILITYIVEHICLE E 71 OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT WASTE TIRE I Jw• 0-4 M' COO /] UNDERGROUND TANK (MONITORINGIREMOVALK El FOOD FACILITY ❑r� DAIRY Ys I- Z $—I /] ABOVEGROUND TANK c: ❑ f'J CHICKEN RANCH/ DOG KENNEL WASTEWATER TREATMENT PLANT /� HAZARDOUS WASTEIHAZARDOUS MATERIALS OL ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS ]TIERED PERMITTED FACIUTYoI ❑ POOLISPA LAND USE APPLICATION SITFR TATTOO/BODY PIERCING ❑ COMPLAINT/RESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) Well and Septic WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464.0138 or mail to the address indicated above. Address ranges will not be accepted. Applications received after 3:00 pm will be processed the next business day. 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. 3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $130 deposit prior to review. ***BOXED AREA- EHD USE ONLY*** EHD 48-08 711115 M W J 111 Y 1. = f_ h 9 o ►N.1al u _ II0� "ORPMERATH EHD 48-08 711115 M W