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RECEIVED <br /> S A N,_J Q A Q U I NEnvironmental Health Department <br /> ---- COU <br /> N1 Y - - MAY 16 ZUlW PUB_iiLIC RECORDS RELEASE APPLICATION <br /> .Li P40NM WAL M-41H <br /> • PEi111MMSERVIMS '��IIII EHD LOG NUMBER: <br /> APPLICANT: Abby Racco BUSINESS/AGENCY:-Live Oak Geo Enylronmental <br /> ADDRESS: 407 W. Oak St. CITY/STATE/ZIP: Lodi, CA 95240 <br /> PHONE(1): 369-0375 PHONE (2): 365-3222 FAX OR E-MAIL: abby@logelodi.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 /> SIGNATURE OF APPLICANT fV94 Raaea DATE May 16, 2018 <br /> 1. List up to ten addresses in the space below. Address ranges WILL NOT be accepted. Select the type(s)of files from the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138,mail to the <br /> address indicated below,or email to info cDsicehd.com. Applications received after 3:00 pm will be processed the next <br /> business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted below. <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 $152 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT EHD USE ONLY <br /> FILES (Specific addresses only,address ranges will not be accepted) <br /> ®Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) ❑CONSUM EP. <br /> ®Other Cleanup Site(Non-LOP) <br /> 21025 S. Jack Tone N• +loon <br /> ®Hazardous Waste ❑DAIRY <br /> ®Tiered Permitted Facility 2 21003 S. Jack Tone Ripon <br /> ®Aboveground Tank ltrt Nh/ Yh CO 5 PWS <br /> UST (Monitoring/Removal) Fon <br /> Hazardous Materials 20449 S. Jack Tone <br /> • No oB no cos <br /> Spill I Release Response Q WATERQUALITY <br /> ®Solid Waste Facility/vehicle a 21123 S. Jack Tone Ripon <br /> i lyM -f rn a (:O <br /> Food Facility El"SITE MITIGATION <br /> ❑Pool/Spa 5 20992 S. Olive Ripon <br /> F]Dairy 1\�7t,11M N� hs fin <br /> F]Land Use Application Sites ❑HOUSING <br /> ❑Septic Pumper Truck/ 6 <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant 0 CUPA <br /> r <br /> AST/HM/HW <br /> Housing Abatement 7 <br /> ❑Motel/Hotel COPA <br /> Chicken Ranch I Dog Kennel 8 UST <br /> Medical Waste Facility <br /> Tattoo/Body Piercing [�JSOLIO WASTE <br /> F]Waste Tire 9 <br /> IN Complaint <br /> ACCOUNTING <br /> E]Other(Please Specify): ❑ <br /> 10 <br /> ) nn t —BOXED AREA-EHD USE ONLY*** <br /> • to <br /> 4'—Z —I� � I � <br /> _2 le 0 1,13 'Toalift i ` <br /> ❑ Records provided by Staff-PP Complete. staff Name: EHD 4a-oe <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br />