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03/30/2010 09:19 20933303 LODI DOWNSTAIRS A PAGE 02/02 <br /> *4 Will <br /> EHD LOG NUMBER <br /> u uD SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> MAR 3 1 2010 600 East Main Street, Stocidon, CA 95202-3029 <br /> Telephone; (209)468-3420 Fax; (209)464-0138 Web: wtv ✓.sjgov.org/e d <br /> ENVIRumvIENT HEALTH <br /> PERMIT/SERVICES { PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: _1((�111��1!_�iLsy' __BUSINESSIAGENCY: <br /> ADDRESS: —(h] Z IndUStrlal Way City/Statalzip Lowtr C'A 45740 <br /> PHONE(1); -20-aE -U-OJ PHONE(2): ,FACSIMILE: 7f19,30 4 8 <br /> TENTATIVE"APPOINTMENT DATE: OS^��'�O Time: gam <br /> om date <br /> (please allow 10 business days frof application submittal-•Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REOUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ DATE 4-12A0 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS _ EHD USE ONLY <br /> Street• Street Name City i 1 _ ❑ Unlit <br /> ?• 50 W. Turner Road =. Lodi— S <br /> z 11.0 7uraer Road Lodi ©ES iU�S unnz �\\X <br /> 3. Unit 3 <br /> 4. �, <br /> 5. _._.-_�._ nit 4 <br /> 6. <br /> T ❑ Unit 5 <br /> �9. - .. ❑ Unit6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> �[ ENVIRONMENTAL HEALTH DEPARTMENT FILES /JPS <br /> /(UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT O SOLID WASTE FACILr1YNF.RICLE UPI �Z <br /> OTHER CLEANUP SITE(NON^LOP) 0 FOOD FACILITY 0 WASTE TIRE IM' <br /> XUNDERCROUND TANK(MONITORINOMEMOVAL) p\- I7 DOG KENNEL 0 DAIRY <br /> )RHAlARDOUS WASTE GENERATOR 0CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY 0 MOTELIHOTEL O PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑TATTOO/Bony PIERCING Q PDOUSPA O LAND USE APPLICATION SITES <br /> In MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) , <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FMDAY 9:00 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. Fax to(209)4640138 or mail to the dress indicated abort Address <br /> ranges will not be accepted-for additional ssslstance with file addresses,contact the EHD. Applications received after <br /> 3:00 per,will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately tan(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 EMD staff may not be immediately availabVe for review. A new application may be <br /> submitted when the file is avallable. <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$105 deposit prior to review. <br /> EHD USE ONLY <br /> U -r <br /> I S 0- II <br /> 0 <br /> e>- <br /> EHD 40-09 8/041UF PUBLIC RECORDS RELEASE APP FORM <br />