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04/05/2012 08:54 2093303 LODI DOWNSTAIIS PAGE 01/01 <br /> RMV-P � FWO LOG NUMBER <br /> SAN N COUNTY <br /> APR 06 2012 ENVIRONMENTALTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> ENVIRONMENTAL HEALTH Telephone: (209)468-3420 Fax; (209) 464-0138 Web: www.sjgov.org/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION _ <br /> APPLICANTp Tina Cheney i3USINESS/AGENCY:N0 0. Anderson &Associates, Inc. <br /> ADDRESS; 902 II] _UStrlal Way CITY/STATEIZIP: Lodi, CA 95240 <br /> PHONE(1): 209-747-0640 PHONE(2): FACsimiu: 209-333-8303 <br /> TENTATIVE"APPOINTMENT DATE: PleaseCa Time: <br /> (Please Allow 10 businoss days from date of application submittal-'Tentative only„must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Tina Cheney DATE 4-6-12 <br /> Electronic Information: ❑ List© Map-Description: <br /> FILE,ADDRESS E7HD USE ONLY <br /> Street Stroef Name City UnIt1 <br /> 1 701 'tory Par ay Lathrop , <br /> 3. <br /> 4` unit a <br /> 2. Unit <br /> 5. -- -- ib <br /> Li umt a <br /> 7. <br /> B. - -- <br /> ❑Unit 5 <br /> 9. <br /> 10' unit <br /> Specific Date Range of information Requested: From _ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT PILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING A13ATEMENTx[], SOLID WASTE FACILmNEHICLE y z <br /> ❑X OTHER CLEANUP SITE(NON-IAP) ❑FOOD FACILITY ❑WASTE TIRE, LtA f J, <br /> ®UNDERGROUND TANK(MONITORING/REMOVAL)Pt, ❑DOG KENNEL ®DAIRY <br /> ®HAZARDOUS WASTE GENERATORK ❑CHICKEN RANCH ®WASTEINATF.RTREATNIENTPLANT <br /> Q TIERED PERMITTED FACILITY ❑MOTELIHOTEL Z PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM•5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List unto 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(2091464-0136 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD, Applications received after <br /> 3:00 pm will be processed the next hesiness day. <br /> 2. 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 /> 3. A file that is actively being worked on by EHD staff may not be Immediately available far review. A now application may be <br /> submitted when the file is available. <br /> d. Any file not returned in the same condition as released will be reorganized by EHD stag°at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> EHa USE ONLY <br /> EHe Ae•0E <br /> WlE9/t p <br />