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DATE RCCEIVC-D EHO LOG NUMBER <br /> a SAN JOA,QUIN COUNTY I <br /> ,j5'IJ I,1 tiL��" ENVIRONMENTAL HENLTH.DEPARTMENT <br /> �iO4 Fast Weber Avcnue, 3rd Floor Stockton, 0195202-2708 <br /> ti'nl' J lc hone: 209\468-3420 f+ax: (209)464-0138 Web: www.'j)gov.Org/ch <br /> APPLICFA -tI 1 7� <br /> y,� Y &n. tBLIC RECORDS RELEASE APPLICATXO.N <br /> ADDRESS:p`9 2 lndusfrial Wa Lodi CA 9524Q BUSINESS/AGENCY:Nei!O.Anderson &Associates Inc. <br /> PHONE(1): 209-367-3701 PHONa (2): FACSIMILE: 209- 6 -422$ <br /> TENTATIVE*APPOINTMENT DATE: a 2Qp7 <br /> (Please allow 10 buelncss days from pate of applicati- <br /> on 20 sutxnittal-* Time: 9.00 am <br /> PP Tentative only.must be t onilmted) <br /> CI CHI=CK III EXPEDITE IREQUEST-05,00 FEE(CASH OR CHECK ONLY).REQUEST PROCESSED IN 3 BUSINESS D <br /> SIGNATURE O AYS <br /> F APPLICANT DATE Ma 74 2QQ7 <br /> UNIT o15TR113UTION Q UnIt 1 a 1"2 Ia Unit 3 0 Unit 4 [� Unit <br /> S ❑ Unit 8 Q Othor(elcctranrCRlstslmaps) <br /> FILE ADDRESS <br /> street# _ Street NameEHD USE O Ly <br /> t' Seidner _City <br /> '2 Escalon r.J� <br /> 3 <br /> 4. <br /> ,/ <br /> 7. <br /> 10. <br /> �� <br /> r� <br /> Specific pato Range of Information Requested;From <br /> to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES F <br /> Z UNDE?RGIR6UNp TANK(VST)CLEANUP <br /> SITE «P a S <br /> EI OTHER CLEANUP SITE(NON-LOP) ( ) tn HOUSING FACILITY <br /> MENT Q SOLID WASTE FACILITYIV C E <br /> EI UNDERGROUND TANK(MONITORINGIREMOVAL ❑ FOOD FACILITY WA$1 E TIRE <br /> HALaRDOt13 WASTE GENEpATOR ) DOG KENNEL ❑DAIRY <br /> 0 TIERED PURMITTRD FACILMY Q CHICKEN RANCH 13 WASTEWATER TREATMr:NT PLANT <br /> ❑TATTOoIbODY PIERCING ❑MOTZ?I!HOTEL 0 PUMPER TRVGKIYAR0iCHEM TOILEtS <br /> Ca MEDICAL WASTE FACILITY POOLISPA ❑LAND USE APPEJCA noN SITES <br /> 0 OTHER(PLEASE SPEcIpy) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RI IEw- MDNOAY-FRIDAY 8:00 AM-5:40PM - FXG6UOENG HOLIDAYS. <br /> 1. List up ko'ten addresses in the space above. Select the types)of files from the fist above by checking the <br /> appropriate boxes). At least one file type MIDST be selected, Fax o 203 464-0'138 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses, <br /> the EHD.Applications recelved after 3:00 pm will be processed the next business day. contact <br /> 2. The EHD will notify the applicant if any EHL?files exist. An appointment for review will be confirmed <br /> approximately ten (10)days atter receipt•Of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may require a$95,00 deposit prior to review. <br /> . I <br /> BHI7�IB.aI; i <br /> '811I[i6 <br />