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15 2017 09:20AM Enviro Assess 8776235493 page 1 <br /> MM■ <br /> ■■■ <br /> ■ � EHDLQGNUMBER <br /> a T1 R mum <br /> SAN JOAQUIN COUNTY <br /> b LOIS ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> WV RCN4ej.TrRLpkAM (209)468-3420 Fax: (209) 464-0138 Web; www.sjgcv.org/ehd <br /> PEk4MfT/SERV1`. <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Cheryl Jackson BUSINESSIAGENCY:Em'iroAs6e63mordPC "':' <br /> ADDRESS: Po Box 1154 CITYISTATEIZIP:Bonnets Ferry,ID 8380* <br /> PHONE (1): B44-742.7311 PHONE (2): FACSIMILE: 877-623-SM <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from dale of application,submittal -"Tentative only-must be confirmed) <br /> G CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH CR CHECK ONLY)-RF-QUEST PROCESSEQ IN 3 BUS;[NESS DAYS <br /> SIGNATURE OF APPLICANT HeatherGemnnrig - - - --- DATE Marek 16;42017 <br /> 0. <br /> Electronic Information. ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE O LY <br /> Street A Street Name City L] Unit 1 <br /> 1. 808 Cherokee Lane Lodi cjD-;? U"-'?7- Z37i2 <br /> 2. o U''Z" 3122 <br /> Unit 2 <br /> 3. <br /> 4, Unit 3 <br /> �G��9 US'i <br /> 4Jf44 <br /> 7. <br /> $, Unit 5 <br /> Specific Date Range of information Requested: From to t 1 00 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Q UNDERGROUND TANK(UST`CLEANUP SITE(LOP) Q MEDICAL WASTE FACILITY Q SOLID WASTE FAC11TYNEHICLE <br /> Q OTHER CLEANUP SITE(IdoN-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> [e]UNDERGROUND TANK(MoNITORINUIREMOVAL) ❑FOOD FACILrnr ❑DAIRY -3-1-7-1 <br /> ABOVEGROUND TANK ❑CHICKEN RANCH(DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTElHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> Q TIERED PERMITTED FACILITY ❑POOLISPA ❑ LAND USE APPUCATION SITES <br /> ❑TA17001BODY PIERCING 0 CONPLAmTIRESPONsE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL.AND SEPTIC PERMIT RECORDS ARE pyAiL.ABLE 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. Faxto 091464-C1138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2, The EHD will notify the applicant if any€HD 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 /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file is available. <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 bythe same applicant may require a$125 deposit prior to review. "* Flti'LI' f3NLY <br /> Received Time Mar. lb. 2017 11 : 24AM No, 1040 <br />