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08/20/2014 16:37 209333830:� LODI DOWNSTAIRS PAGE 02/02
<br /> DATE RECEIVEDq EHD LOG NUMBER
<br /> SAN JOAQUIN COUNTY P L E C � � I
<br /> RECEIVED 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 /> , T
<br /> ENVIRONMENTALHEALiH PUBLIC RECORDS RELEASE APPLICATION
<br /> ocub EaulrFS -'
<br /> APPLICANT:Heather Shaddox BUSINESS/AGEhICY: Neil O. Anderson& Associates
<br /> ADDRESS: 902 Industrial Way CITY/STATEIZIP: 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-*Tentative only-must bo confirmed)
<br /> ❑ CHECK BOX TO RXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS
<br /> SIGNATURE OF APPLICANT DATE August 21, 2014
<br /> Electronic Information: ❑ List❑ Map--Description:
<br /> FILE ADDRESS EHD USE ONLY
<br /> Street# Street Name city
<br /> El Unit 1
<br /> 1. 200 _ N.Beckman Road EE - Lodi l
<br /> 2. 880 - E.Victor Road ��r Lodi - _ - /un_it 2_
<br /> 3. 845 - E. Pine Street i:;� VJ T- Lodi
<br /> 4. 900 E.Victor Road Lodi IJ/ Unit
<br /> S. 920 � E.Victor Road --_- Lodi --•---• - -- --�--• ._ -•--•••( -----�.
<br /> c� v�T
<br /> S. 873 E. Pine Street �rr Lodi _ �Unit a
<br /> 7. 861 E, Pine Street f Lodi - - -- -- - - `
<br /> 8. 921 E.Pine Street t-4 Lodi - _ ❑Unit a-
<br /> 9. 930 - E.Victor Road Lodi
<br /> 10. 940 _ E.Victor Road ^^II Lodi l bUnit s
<br /> /r
<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 FACILITYNEHICLE TNQ '
<br /> ®OTHER CLEANUP SITE(NON-LOP) [71HOUSING ABATEMENT ®WASTE TIRE
<br /> X UNDERGROUND TANK(MONITORINWRFMOVAL) ❑FOOD FACILITY DAIRY
<br /> ®ABOVEGROUND TANK ❑CHICKEN RANCH]DOG KENNEL WASTEWATER TREATMENT PLANT
<br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEL/HOTEI. ®PUMPERTRUCKNARD/CHEMICAL TOILETS
<br /> ® TIERED PERMITTED FACILITY Q POOLISPA LAND USE APPLICATION SITES
<br /> ❑TATrooIBODY 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 mail to the address indicated above. Address
<br /> range's will not be accepted-for additional assistance with file addresses, contact the EHD, Applications received after
<br /> 3:00 pnt will be processed the next business day.
<br /> 2. The EHD will notify the applicant if any END 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 reviev/. ,;;� .,;.. b, E '
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<br /> Received Time ug, 21 2014k 6:33PM„No. 89011. 1 , ' 11 7L1,
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