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RX� , � � <br />� V D SAN JOAQUIN COUNTYEHD LOG NUMBER <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />MAY 20�G 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />ElAq-RO MEWAL B HEAL` -€ <br />FERPATISEF'VICESS PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Abby Racco BUSINESS/AGENCY: Live Oak Geo Environmental <br />ADDRESS: 407 W. Oak St. CITY/STATE/ZIP: Lodi, CA 95240 <br />PHONE (1): 369-0375 PHONE (2): 365-3222 FACSIMILE: 369-0377 <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 - $130 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT AEzy 2aow DATE 5-26-16 <br />Electronic Information: ❑ List ❑ Map — Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />Street t <br />Street Name <br />City <br />1. <br />23800 <br />N. Jack Tone Rd. <br />Acampo <br />❑ Unit 1 <br />2. <br />23490 <br />N. Jack Tone Rd. <br />Acampo <br />3. <br />14680 <br />E. Jahant Rd. <br />Acampo <br />*fA *f:em /Cwm [9'6nit 2 <br />4. <br />14615 <br />E. Peltier Rd. <br />Acam o <br />Unit 2H <br />5. <br />�� 1 �' "� Omit 3 <br />6. <br />7. <br />O!nit 4 <br />$. <br />2 SITE MITIGATION <br />9. <br />❑ Unit 5 <br />10, <br />Specific Date Range of Information Requested: From all available to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />® UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILITYIVEHICLE <br />® OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE <br />® UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ FOOD FACILITY ❑ DAIRY <br />® ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />® HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />® TIERED PERMITTED FACILITY ❑ POOLISPA ® LAND USE APPLICATION SITES <br />❑ TATTOOIBODY PIERCING Z COMPLAINT/RESPONSE RECORDS ® OTHER (PLgAuSfaCe'�'lJ�surFace Rpt <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 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 />it <br />