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EE <br /> lel" ` rR of iVEHD LOG NUMBER <br /> ��� �� <br /> M Q IN COUNTY <br /> f V, NOV ?015 EwRoigmENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wvvw.sjgov.org/ehd <br /> eNVIRONit4ENTAL HE`;E:€'i-j <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APLiCA1`4T4Bacco BUSINESSiAOENCY: Live Oak GeoEnvironmental <br /> ADDRESS: 407 W. Oak CITY/STATE01P: Lodi, CA 95240 <br /> PHONE(11: _ PHONE(2): 365-3222 FACSIMILE: 369-0377 <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, FEE(CA$IJ OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic information: ❑ List❑ Map—Description: <br /> FILE ADDRESS <br /> Street# Streat.Name City EHD USE:ONLY <br /> 1. <br /> 15,1 tic S• SSar, <br /> ZSg3� n Unit 3. S. �tSSda'i �• �5� `LrJ Cdr• '� unit 2 <br /> 4. Z3sva S, KRbSr1t1 •. <br /> 5, G�sS oti tom— C�ta.►�k,- X5-Lo <br /> 7. <br /> unIL 4 <br /> y SITE MITIGATION <br /> 10. <br /> ❑unit 5 <br /> Specific Data Range of Information Requested; From all availaklo <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES u <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SrrE(NON-LOP) Q HOUSING A13ATEMENT L]WASTE TIRE <br /> ® <br /> UNDERGROUND TANK(MONITORINWREMOVAL) [I FOOD FACILITY ❑DAIRY <br /> r®rrr��ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WA$TFWpTER TREkTMENT Pi ANT <br /> LtJ HAZARDOUS WASTE/HAZARDOUS MATERIALS L]MOTEL/HOTEL El PUMPER TRUCKI.YARDICHEMICAL TOILETS <br /> ®TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND UsE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING R COMPLAINTIRESPONSE RECORDS d OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:60 AM-5.oOPM(EXCLUDING HOLIDAYS) <br /> 1- Llst 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 typo MUST be selected. Fax to(2091464-0138 or mall to the address indicated ahovP Address <br /> ranges will not be accepted.Applications recelved 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. Appolntments <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. ***6pXED AREA-EHD USE ONLY*** <br /> n7u1 Q� I Ewe �i(e ar �� >z ,sol . 2SfG3K SDS Q� vl1 0. !aA <br /> �er �3VC rV%QeJ Ll� Pile r k r/' ter � dosSOv � 2-, _ n,, ��.00wA� 4- (v 61r3Z 6000GOrool �t� �r <br /> Z1 00 o, ILS V", UJ. Nvikek co,,Y4l,,,-f (_0C"),7,►]7 lvr z�I �.SS�P& v1.G0. <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> END 4306 <br /> Received Time Nov, 2. 2015 9: 27AM No, 9931 . <br />