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SAN <br /> DATE REC�EIVE�D��� _ AQUIN COUNTY EHD LOG NUMBER <br /> �5,> L�Il`\�"I I� ENVIRONMENTQI HEALTH X DEPARTMENT <br /> 600 E.Main Street, Stockton,CA 95202-3029 <br /> JUN (} 2009 Telephone: (209)469-3420 Far: (209)464-0138 Web: www.Sjgov_ox 15 <br /> ,n 01'JEN i '4PV-QHEAL1 PUBLIC RECORDS RELEASE APPLICATION <br /> nrnrt I <br /> K�d�)�k�iT`ADby KaccO BUSINESS/AVENCY: Live Oak GeoEnvironmental <br /> ADDREss: 407 W. Oak St., Lodi, CA 95240 <br /> PHONE(1): (209) 369-0375 PHONE(2): FACSIMILE: (209)369-0375 <br /> TENTATIVE"APPOINTMENT DATE: June 22, 2009 Time, 9:00 am <br /> (Please allow 10 business days from d2tQ of application submittal-*T*ntadvo only-muLt ba conflrtnad) <br /> ❑ CHECK Box TO EXPEDITE REqu .596.0 E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑List 0 Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ unit 1 <br /> 19690 N.St. Rt. 99 E. Frontage Acampo <br /> 2• 19690 N. Highway 99 Acampo �,, '^ ❑ unit 2 <br /> 3. <br /> 4. Unit 3 \ <br /> t3. Unit 4 <br /> 7. <br /> $ ❑ unit s <br /> L10. <br /> Clunit s <br /> Specific Date Range of Information Requested-From all available to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE <br /> t7 OTHER CLEANUP SITE(NON-LOP) D FOOD FACILITY O WASTE T)Re <br /> El UNDERGROUND TANK(MONRORING/REMOVAL) ❑DOG KENNEL Q DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 0 TIERrD PERMITTED FACILITY ❑MOTHL/HOTGL ❑PUMRBR TRUCKIYARDICHEM TOILETS <br /> ❑TATTOO/BODY PIERCING 0 POOL/SPA 1.7 LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY 13 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMlT RECORDS ARE AVAILABLE FOR REvIEw - MONDAY-FRIDAY 8:00 AM-b:UOPM • EXCLUDINO 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 f209)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 atter 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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> LH04049 9V=006 wab <br />