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V <br />DATE RECEIVED ) ` • '^ EHD LOG NUMBER <br />SAN JOAQUIN COf� <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 81 <br />g/ <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Tammy Woods NOA/Terracon <br />BUSINESS/AGENCY: <br />ADDRESS: 902 Industrial Way CITY/STATE/ZIP: Lodi, CA95240 <br />PHONE (1). 209-367-3701 PHONE (2): FACSIMILE: 209-333-8303 <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_ Tammy Woods for NOA/Terracon DATE 08/10/2015 <br />Electronic Information: ❑ List ❑ Map- Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />Stre et# <br />Street Name ° <br />city <br />1• <br />1240 <br />100 <br />E. Pine Street 3 <br />S. Cluff Avenue j4rfE <br />Lodi <br />Lodi <br />4? <br />k* I= <br />2. <br />3. <br />1310 <br />_... <br />E. Pine Street FF <br />Lodi <br />❑ Unit s <br />IlLkF <br />.4. <br />4' <br />__._.._._-----.-_'--�--'--- <br />❑ Unit 2 <br />5 <br />El unit 2H <br />05r�+ <br />LI Unit 3 <br />6. <br />7. <br />'n <br />8 <br />a- <br />` _ <br />❑ Unit <br />9. <br />'� <br />/❑ SITE MITIGATION <br />10. <br />S ecific <br />D t R <br />El Unit 5 <br />P a e ange of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />IXI UNDERGROUND TANK (UST) CLEANUP SITE (LOP) I1 MEDICAL WASTE FACILITY W SOLID WASTE FACILITYIVEHICLE <br />XI OTHER CLEANUP SITE (NON -LOP) ® HOUSING ABATEMENT WASTE TIRE <br />j UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ FOOD FACILITY U DAIRY <br />j ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />IyX I HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ISI PUMPER TRUCKIYARO/CHEMICAL TOILETS <br />al TIERED PERMITTED FACILITY <br />❑ POOL/SPA LAND USE APPLICATION SITES <br />El TATTOOIBODY PIERCING jCOMPLAINTIRESPONSERECORDS LANOTHER(PLEASEWell/Septic permits <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br />I. List uo to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate <br />box <br />(ea). d 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 deoosit Drior to rpvipw_ ***RnYrn AocA -ran lieu nkl. v*** <br />