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v <br /> s0 DATE RECEIVEDEHD LOG NUMBER <br /> SO SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> NOV 12 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:wwvr.sjgov.org/ehd <br /> ENViROt MENI`IALHEALTH <br /> PERNITIBEPWICES PUBLIC RECORDS RELEASE APPLICATION! <br /> APPLICANT: Abbv RaCCO BUSINESS/AGENCY: Live Oak GeoEnviron mental <br /> ADDRESS: 407 W, Qak St. CITY/STATFJZIP: Lodi, CA 95240 <br /> PHONE(1): 569-0375 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 REQU 30 FEE(C OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 1 I d S <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name City 42 <br /> 1. 1�-(n 2� ✓r w�)d vs o e-�( Sf rr,�4 WCV14:�O_), <br /> Nc c.!),�2. I�9'o ► r1�5 �❑unitt <br /> eC/ 3. <br /> t I 1 Unit 2 <br /> 4. Unit 2H <br /> 5. <br /> 6. Unit 3 <br /> 7• Unit 4 <br /> - 8. 0 SITE MITIGATION <br /> 9. <br /> 10. ❑unit s <br /> Specific Date Range of Information Requested From all available to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES p� <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) L]MEDICAL WASTE FACILI'iY Ll /VSOLID WASTE FACILI EHIC E +/ <br /> ®OTHER CLEANUP SITE(NON-LOP) L] RE, �HOUSING ABATEMENT 0 WASTE TI �1 �/ WI� <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL� ❑FOOD FACILITY ❑DAIRY Tit <br /> II-) <br /> ®ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT Z J.15 <br /> ( HAZARDOUS WASTE/ ElMOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILS <br /> RI TIERED PERMITTED FACILITY •:7� ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING COMPLAINTIRESPONSE RECORDS ❑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 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 mall to the address Indicated above.. Address <br /> ranges will not be accepted.Appllcatloris received after 3.00 pm will be processed the nsxt business day. <br /> 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted abova. <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 de osi for to review. 111PDXED AREA- EHD USE ONLY** <br /> f W <br /> << -� <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD d"6 7/1/15 <br /> Received Time Nov, 10, 2015 4: 34PM No. 9996 <br />