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DATE RECEIVEDEHD LOG NUMBER <br /> RECEIVED <br /> � SAN aIOAQUIN COUNTY 40 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> MAR 0 4 2016 1868 East Hazelton Avenue, Stockton, CA 95205-6232 °� 1 t <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENTALHEALTw <br /> PERM/ PUBLIC RECORDS RELEASE APPLICATION <br /> PERi�iiT/SERVICES <br /> APPLICANT: Abby Racco BUSINESS/AGENCY: Live Oak GeoEnvironmental <br /> ADDRESS: 407 W. Oak St. CITYISTATE/ZIP: Lodi, CA 95240 <br /> PHONE(1): 369-0375 PHONE(2): 365-3222 FACSIMILE: <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 Abby Racco DATE 34-16 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 1. 21025 S. Carrolton Rd. k* V, NO 314 <br /> 2. 20991 S. Carrolton Rd. Ripon CQ NO ❑ Unit <br /> (� 3. 21399 S. Carrolton Rd. Ripon in r Un;I 0116 lt2 <br /> W 4• 18832 E. Mello Ripon Cb, No cd/ ❑ Unit 2H <br /> �J 5. 19102 E. Mello Ripon rA5q, !A)O�c,0/4 <br /> gd U1+� ,FFM <br /> s• 303 S. Reid Ave. . :91init 3 <br /> LL <br /> Reid Ave. (FA0018566, R00001869) i l n � ❑ Unit <br /> SITE MITIGATION <br /> .0 Unit 5 <br /> Specific Date Range of Information Requested; From all available to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES /�,.. <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE�F��A f L��'T"""YIVVEHICLE ,, -Qn <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRe y ,�7�j -ro/-(�T <br /> ®UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY V I..f--. <br /> ®ABOVEGROUND TANK CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ®HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEUHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ®TIERED PERMITTED FACILITY ❑POOLISPA _ ®LAND USE APPLICATION SITES <br /> F1n <br /> TATTOO/BODY PIERCING IA.:COMPLAINTIRESPONSE RECORDS ®OTHER(PLEASE SPECIFY) SSCR for 303 S.Reid <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 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. ***BOXED AREA-EHD USE ONLY*** <br /> I <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 4"6 71115 <br />