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DATE RECEIVED EHD LOG NUMBER <br /> RECEIVED <br /> ® SAN TAL HEAQUIN COUNTY 191'Z2-q <br /> 9� �A `�° ENVIRONMENTAL HEALTH DEPARTMENT <br /> SEP p 4 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: , AAMY WOODS BUSINESS/AGENCY: NOA/TERRACON <br /> ADDRESS: 902 INDUSTRIAL WAY CITY/STATE/ZIP: LODI. CA 95240 <br /> PHONE(1): 209-367-3701 PHONE(2): ;FACSIMILE: 209-333-8303 <br /> cdn� <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 ONLYI-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT TKWOODS@TERRACON.COM DATE 09-03-15 <br /> Electronic Information: ❑ List ❑ Map-Description: <br /> FILE ADDRESS <br /> Street# Street Name Clh, EHD USE ONLY <br /> 1. 6S. EL DORADO STREET STOCKTON I✓Ft= <br /> 2. 49 S. HUNTER STREET I STOCKTON VC- <br /> 3 24 ❑Unit 1 } <br /> S. HUNTER STREET � STOCKTON LOP _GO E3Unit2 lly <br /> 4 22 E. MARKET STREET I STOCKTON LOP }R2 a1-15-CO ®'Unit 2H <br /> S. 141 ELDORADO STREET I STOCKTON LOP I- MWY c <br /> 6. DU <br /> nit 3 <br /> 7. �/ <br /> Od nit4 <br /> 8. <br /> SITE MITIGATION <br /> 9. <br /> 10. �� <br /> td'Unit 5 <br /> Specific Date Range of Information Requested: From ALL to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> nRI UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY r SOLID WASTE FACILITYNEHICLE <br /> Ors'OTHER CLEANUP SITE(NON-LOP) Fl HOUSING ABATEMENT LX WASTE TIRE <br /> 13�UNDERGROUND TANK(MONITORING/REMOVAL) LJ FOOD FACILITY ❑DAIRY <br /> �X ABOVEGROUND TANK _❑CHICKEN RANCH/DOG KENNEL R WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS IRI MOTEL/HOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> �l TIERED PERMITTED FACILITY ❑POOL/SPA 5�LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING I3d COMPLAINT/RESPONSE RECORDS <br /> ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At 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 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 4a-06 <br /> ]It116 <br />