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R F,.°LVE CE <br /> c�C SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> [a rz NOV 0 2 2015 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, GA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www-sjgov.org/ehd <br /> NVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Abby Bacco BUSINESS/AGENCY: Live Oak GeoEnvironmental <br /> ADDRESS: 407 W. Oak St CITY/STATE2IP: Lodi, CA 95240 <br /> PHONE(1): 369-0375 PHONE(2): 3Q5-3222 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 Tq EXPEDITE REQUEST- FEE(CA OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE t <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS <br /> Street# Street Name City EHD USE ONLY <br /> 1. ySlOo S• �xSto'v� .-rrQ <br /> z• ZSoo 1 S. KcLCSav� �- <br /> 3, ZS g3a{• .. Unit1 <br /> S• �ssav� <br /> 4 <br /> Unit 2 <br /> y35ov S, /C0.bsd{1 ❑Unit2rl «�EO <br /> 5' ? Ga.CSo+tif�- Ckavkw Pre fi� •- <br /> 6. {nool6S�i� <br /> 7, unit 3 <br /> 8 I�Unh4 <br /> 9. <br /> SITE MITIGATION <br /> 10 <br /> ❑Unit S <br /> specific Date Rangeot Information Requested: From ill aV211flh1e to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINGfREMOvAL) ❑FOOD FACILITY ❑DAIRY <br /> ®ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ®HAZARDOUS WASTENAZARDOUS MATERIALS ❑MDTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ®TIERED PERMITTED FACILITY ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ®COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-S:OOPM(EXCLUDING HOLIDAYS) <br /> 1- b!!&xOD ro ten addresses in the space above. Select the type(e)of files from the list above by checking the appropriate <br /> o (as). At least one file type MUST be selected. Fax to(2091464-0138 or mall to the address indicated above Address <br /> ranges will not be accepted.Applications recelved alter 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 /> S. The EHD will notify the applicant If any EMD 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. •"BOXED AREA-EHD USE ONLV"' <br /> ❑ Records provided by Staff-PPR Complete. staff.Name: <br /> EHD4e 06 <br /> Received Time Nov. 2. 2015 9: 27AM No, 9931 . <br />