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HLGEID <br /> Ut it Kt,L,clvtU SAN JOAQU IN COUNTY �••✓ �V V •.�•.��.. <br /> DEC 2016 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue,Stockton,CA 95205-6232 <br /> ItIUIRQV WALL TFielephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd yv, <br /> PFI1t(1fpZ;tVf�,E PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Hai Ngo/Tammy Sibbitt BUSINESS/AGENCY: Save Mart Supermarket <br /> ADDRESS: 1800 Standiford Ave. CITY/STATE/ZIP: Modesto,CA 95350 <br /> PHONE(1): (2)• X01) - toa9 FAX OR E-MAIL: <br /> Please allow 10 business days from date o app icatlon 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 /> IGCHECK BOX TO EXPEDITENATURE OF APPLICANT JEST-$130 FEE(CASH-OR K ON -REQUEST PROCESSED N i BUSINESS PAYS <br /> S <br /> 1. List up to ten addresses in the space below. Se e t the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or all 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. <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> UNDERGROUND TANK(UST) Srest# Street Name City <br /> CLEANUP Sim(LOP) <br /> 530 W.Lodi Ave Lodi �1�1,^N�r//� co::s rtn <br /> I]OTHER CLEANUP SITE(NON-LOP) U I♦/1 <br /> ❑HAZARDs WAs1E ❑O'n' <br /> W <br /> ❑TIERED PERMITTED FACILITY <br /> ABOVEGROUND TANK PWS <br /> UST (MONNORING/REMOVAL) <br /> 3 <br /> ®HA2AROGLIS MATERIALS <br /> ❑SPILURELEASE RESPONSE ❑WATER OVAUI <br /> ❑SOLID WASTE FACILITY/VEHICLE 4 <br /> FOOD FACILITY <br /> ❑POOL/SPA I I —I� S <br /> ❑ SSmTK.I.iKK: <br /> DNRY /�YW//INIi'IL <br /> ❑LAND USE APPLICATION SUES ❑Houswb <br /> SEPTIC PUMPER TRUCK I S <br /> YARD/CHEMICAL TOILETS <br /> ❑WASTEWATERR <br /> TRFATMENL ANT CUPA <br /> HOUSING ABATEMENT T <br /> IArf <br /> �MOTEUHOTEL CUPA-lN2K,UeT <br /> ❑CHICKEN RANCH/DOG KENNEL <br /> Fj e <br /> MEDICAL WASTE FAGILRY <br /> ❑TATTOOISOOY PIERCING ❑SODD W-m <br /> WA5TE TIRE 9 <br /> COMPLAINT <br /> ❑ACCOVHnNb <br /> OTNER(PLPASE SPECIFY): <br /> 10 <br /> Specific Date Range of Information Requested: From January12016 to Present <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW' MONDAY-FRIDAY 8'00 AM-6:00PM(EXCLUDING HOLIDAYS) _ <br /> `•`BOXED AREA-EHD USE ONLY—* <br /> ❑ Records provided by Staff-PPR Comolete. Staff Name: <br />