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11/01/2016 10 : 52 : 02 AM –0500 Terracon Fax Server PAGE 2 OF 2 <br /> * RUSH EHD LOG NUMBER <br /> iVF- , SAN .10AQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> K")V 0 9 2016 1868 East Hazelton Avenue, Stockton, CA 95205-6232 q957 <br /> -'�{A��/^�*��,c►�r��L Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: vwvw.sjgov.org/eh <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Sadie Bodiford BUSINESS/AGENCY: Terracon <br /> ADDRESS: 50 Goldenland Court. Suite 100 CITY/STATE/ZIP: Sacramento, CA 95834 <br /> PHONE (1): 916-246-5080 PHONE (2): FAX OR E-MAIL: sadie.bodiford@terracon.com <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 /> X CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List ❑ Map–Description: <br /> FILE ADDRESS <br /> EHD USE ONLY i1�3 <br /> Street# Street Name City <br /> ')_1i025 West Hazelton Avenue Stockton f �>�P/ L�fvrY I�CIO At�D� <br /> ❑ Unit 1 <br /> 2. <br /> 3. R"Unit 2 <br /> 4. // 1 I El Unit 2H <br /> 5. 11�f�v1 (//� ( [9UnR 3 <br /> 6. ViUnit 34 <br /> 7. ❑ Unit 4 <br /> 8. SITE MITIGATION <br /> 9. <br /> ❑ Unit 5 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> [x]UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTELIHOTEL ❑SOLID WASTE FACIUTYNEHICLE <br /> [X]OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑FOOD FACILITY <br /> [XI UNDERGROUND TANK(MONITORING/REMOVAL) ❑WASTE TIRE ❑DAIRY,POOLISPA <br /> [XI ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> [XI HAZARDOUS WASTE ❑MEDICAL WASTE FACILITY ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> [XI HAZARDOUS MATERIALS ❑TATTOO/BODY PIERCING ❑LAND USE APPLICATION SITES <br /> U TIERED PERMITTED FACILITY [X]COMPLAINTIRESPONSE RECORDS ❑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 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)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 notifythe 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 maxim um 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. <br /> —BOXED AREA-EHD USE ONLY*** <br /> 0 2 <br /> 1'9 [?nnnrrtc r%rnL1irAnr1 by c+nff-DDR r_ Kin Intn Staff Name: <br /> Received Time-Nov, 1, _2016- 8:48AN�No, 0256 <br />