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DATE RECEIVED ' SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> CIV ENVIRONMENTAL HEALTH DEPARTMENT q a <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> N 13 201 elephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> PERMITZEl VifA 1MY WOODS NOA/TE O <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: 902 INDUSTRIAL WAY CITY/STATE/ZIP: LODI, CA 95240 <br /> PHONE(1): 209-367-3701 _ PHONE (2): FACSIMILE: 209-333-8303 <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 REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT TKWOODSCcDTERRACON.COM DATE 01/12/2016 <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS <br /> Street# Street Name City EHD USE ONLY <br /> 12. 8020 <br /> 6484 N. WAVERLY ROAD LINDEN — i CD ) 1H. <br /> N. WAVERLY ROAD LINDEN CIO ❑Unit 1 <br /> 3. <br /> alj'nit 2 <br /> 4. <br /> ❑,Unit 2H <br /> 5. <br /> 6. (`Unit 3 U���✓�✓ <br /> 7 ` J D u i±4 <br /> 8. V E3'SITE MITIGATION <br /> 10. 0 ) <br /> D'Unit 5 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 71 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Z MEDICAL WASTE FACILITY SOLID WASTE FACILITYIVEHICLE <br /> 0 OTHER CLEANUP SITE(NON-LOP) Q HOUSING ABATEMENT ,WASTE TIRE <br /> Z UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> Q ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> Z HAZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> D TIERED PERMITTED FACILITY ❑POOLISPA LAND USE APPLICATION SITFs <br /> ❑TATTOO/BODY PIERCING Z COMPLAINT/RESPONSE RECORDS Q OTHER(PLEASE SPECIFY) Well and Septic <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING forl 1 st address <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.Applications received after 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 /> 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 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** <br /> 0 Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 <br /> 7/1/15 <br />