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08/20/2014 16:37 2093338303 LODI DOWNSTAIRS PAGE 02/02
<br /> DATE RECEIVED _ SAN JOAQUIN COUNTY EHD LOG NUMBER
<br /> E
<br /> _ ,-EI r tCjE— ENVIRONMENTAL HEALTH DEPARTMENT
<br /> AUG 2 2 2014 1868 East Hazelton Avenue, Stockton, CA 95205-6232-
<br /> Telephone:
<br /> 5205-6232Telephone: (209) 468-3420 Fax: (209) 464--0138 Web: vAm.Sjgov.org/ehd +
<br /> ENVIRONMENTALHEA,LTH PU13LIC RECORDS RELEASE APPLICATION
<br /> _orolifilTISERVICFS
<br /> APPLICANT: Heather Shaddox BUSINESS/AGENCY: 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 /> TENTA TWE`APPOINTMENT DATE: __. Time:
<br /> (Blease allow 10 business days from date of application submittal-"Tentative only-must be confirmed)
<br /> ❑ CHECK BOX TO F-XPEDITE REQUEST-3125 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 /> iO
<br /> Street ff Street Name City
<br /> Unit 1
<br /> 1. 200 N, Beckman Road Lodi Ii Lo l
<br /> 2. 880 E Victor Road Lodi _ _ � _ unit 2_
<br /> 3, 845 E. Pine Street Lodi
<br /> 4. 960 /q00la E.Victor Road , u, Lodi Unit 3 `1
<br /> S. 920 E.Victor Road Lodi
<br /> S. 873 E. Pine Street Lodi 1�7_ Unft4
<br /> 7. 861 E. Pine Street Lodi `
<br /> 8. 921 E,Pine Street — Lodi ❑Unit 5
<br /> 9. 930 E.Victor Road Lodi
<br /> 101 940 1 E.Victor Road Lodi Unit 6
<br /> Specific Date Range of Information Requested: From to
<br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES
<br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 MEDICAL WASTE FACILITY OSOLID WASTE FACILITYNEHICLE
<br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ®WASTE TIRE
<br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY DAIRY
<br /> ®ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL Z WASTEWATER TREATMENT PLANT
<br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELMOTEL ®PUMPER TRUCKIYARDICHEMICAL TOILETS
<br /> ® TIERED PERMITTED(FACILITY Q POOLISPA LAND USE APPLICATION SITES
<br /> ❑TATT061BODY PIERCING ®COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY)
<br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS)
<br /> 1. List upto 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 abovo, Address
<br /> ranges will not be accepted-for additional assistance with file addresses, contact the EHD. Applications receivad 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 vvill 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 flle not returned in the same condition as released will be reorganized by EHD staff at the expanse of the applicant.
<br /> Future file reviews by the same applicant may require a$125 deposit prior to review. ;;t,.,.,;.: b' t ?:'r
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