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RECEIVED <br /> SAN J O A Q U I N Environmental Health Department <br /> �.. --COUNTY � Y �' 1 PUI�LIC RECORDS RELEASE APPLICATION <br /> IWCWAL1­ZU­H �r\U, � 3�qZ <br /> PEMMMSUZACES EHD LOG NUMBER: <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 FAX OR E-MAIL: abby@loqelodi.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 /> SIGNATURE OF APPLICANT fV94 Raeea DATE May 16, 2018 <br /> 1. List up to ten addresses in the space below. Address ranges WILL NOT be accepted. Select the type(s) of files from the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138,mail to the <br /> address indicated below,or email to info(d)sicehd.com. Applications received after 3:00 pm will be processed the next <br /> business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted below. <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$152 deposit prior to review. 2� <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS -4 ' (Q ?S (� <br /> HEALTH DEPARTMENT ( p y 9 accepted) EHD USE ONLY <br /> FILES (Specific addresses only,address ranges will not be acce ted <br /> ®Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) ❑CONSUMER <br /> ®Other Cleanup Site(Non-LOP) ' 21025 S. Jack Tone N• +pon <br /> IL]l Hazardous Waste i 5P ❑DAIRY <br /> ®Tiered Permitted Facility z 21003 S. Jack Tone Ripon <br /> ®Aboveground Tank A$j <br /> N UST (Monitoring/Removal) � FOn ❑PWS <br /> Hazardous Materials 20449 S. Jack Tone <br /> iJ Spill I Release Response <br /> • No DB Y10 CU 5 <br /> ®Solid Waste Facility/Vehicle 4E3WATER QUALITY <br /> 21123 S. Jack Tone „Rion <br /> F1 Food FacilityAsy, /1co <br /> Pool/Spa SITE MITIGATION <br /> Dairy 5 20992 S. Oliveqq Ripon <br /> F] Land Use Application Sites 11�T' hST ffVV)HM, tit colsp <br /> ❑Septic Pumper Truck/ 6 ElHOUSING <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant CUPA <br /> rF-1 Housing Abatement 7 AST I HM f HW <br /> 0 Motel/Hotel <br /> ❑Chicken Ranch/Dog Kennel CUPA <br /> Medical Waste Facility 8 UST <br /> ❑Tattoo/Body Piercing <br /> SOLID WASTE <br /> Waste Tire g <br /> [�Complaint <br /> F1 Other(Please Specify): ❑ACCOUNTING <br /> 10 <br /> —BOXED AREA-EHD USE ONLY— <br /> Ask -I(, 1� -Gr ,�t� Q C�.� Ii k recc'wk c9+ <br /> -2 - 3 b 111'13 5. 1 'in WMEI)tsr Z111a. <br /> ❑ Records provided by Staff-PM Complete. Staff Name: EHD as-os <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />