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08/20/2014 16:37 20933383P" LODI DOWNSTAIRS PAGE 02/02 <br />DATE RECEIVED EHD LOG NUMBER <br />RECEIVED <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />AUG 2 2 2014 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br />01:0eAtT/CI=AVIr�S -- <br />APPLICANT: Heather Shaddox BUSINESS/AGEbICY: Neil O. Anderson & Associates <br />ADDRESS: 902 Industrial Way CITY/STATE/ZIP: Lodi, CA 95240 <br />PHONE (1): 209-367-3701 PHONE (2):209-747-1000 FACSIMILE: 209-333-8303 <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal - "Tenrat1ve only - must bo confirmed) <br />❑ CHECK BOX TO RXPEDITE REQUEST -$125 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />A <br />SIGNATURE OF APPLICANT DATE Auciust 21, 2014 <br />Electronic Information: ❑ List ❑ Map — Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />" <br />i Unit 1 <br />� <br />y un_It 2_ <br />Street # <br />Street Name <br />N. Beckman Road <br />City <br />Lodi <br />1. <br />200 <br />2. <br />880 <br />E Victor Road <br />Lodi <br />3. <br />845 <br />E. Pine Street <br />_ <br />Lodi <br />--- -- _ �� unit 3.- <br />p unit 4 <br />❑ unit 5 <br />4. <br />900 <br />E. Victor Road k ru,�,ti _ <br />�! <br />Lodi -- - <br />Lodi <br />5. <br />920 <br />E. Victor Road <br />G. <br />7. <br />8. <br />873 <br />861 <br />E. Pine Street <br />E. Pine Street <br />Lodi <br />Lodi <br />921 <br />E. Pine Street <br />Lodi <br />9. <br />930 <br />E. Victor Road <br />Lodi <br />Lodi <br />unit 6 <br />10. <br />940 <br />E- Victor Road <br />Specific Date Range of Information Requested: From 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 A13ATEMFNT ® WASTE TIRE <br />UNDERGROUND TANK (MONITORING/REMOVAL) ❑ FOOD FACILITY DAIRY <br />® ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL WASTEWATER TREATMENT PLANT <br />HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTELIHOTEL ® PUMPER TRUCKNARDICHEMICAL TOILETS <br />® TIERED PERMITTED FACILITY ❑ POOLISPA Z LAND USE APPLICATION SITES <br />❑ TATTOO/BODY PIERCING [0 COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE; AVAILABLE FOR REVIEW: MONDAY -FRIDAY 5:00 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 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 business 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 for review. A new application may be <br />submitted when the file Is available. <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 $125 deposit prior to review. ;;cBd,;EI�}`'1..li,A^.ir..'._•.;:',... ;pal <br />ecelve <br />�Y:aM''•:4'�1ZP <br />CY <br />