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RMEIV-- EHD LOG NUMBER A OAUI COUNTY �� 2�1 ENVIRONMENTAL HEALTHDEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd �E'IRONMENTA1- HEALTH PERMIT/SERVICES PUBLICLAPPLICATION ADDRESS: 902 INDUSTRIAL WAY PHONE (1): 209-367-3701 PHONE (2): BUSINESS/AGENCY: NOA/TERRACON CITY/STATE/ZIP: LODI. CA 95240 FACSIMILE: 209-333-8303 Please allow 10 business days from date of application submittal for the records to be available. Staff will contact you to arrange an appointment date and time to review the requested records. ❑ CHECK BOX TO EXPEDITE REQUEST - $130 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT TKWOODS@TERRACON.COM DATE 09-11-15 Electronic Information: ❑ List ❑ Map — Description: FILE ADDRESS Specific Date Range of Information Requested: From_ ALL to ENVIRONMENTAL HEALTH DEPARTMENT FILES X UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑MEDICAL WASTE FACILITY iX SOLID WASTE FACILITYIVEHICLE XOTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT IX WASTE TIRE 15� UNDERGROUND TANK (MONITORING/REMOVAL) ❑ FOOD FACILITY ❑ DAIRY 1A ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL [ WASTEWATER TREATMENT PLANT HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS f TIERED PERMITTED FACILITY ❑ POOLISPA LAND USE APPLICATION SITES U TATTOOIBODY PIERCING 13d COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above Address ranges will not be accepted. Applications received after 3:00 pm will be processed the next business day. 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. 3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 4. Any file riot returned in the same condition as released will be reorganized'by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $130 deposit prior to review. ***BOXED AREA - EHD USE ONLY*** 711115 Street # Street Name EHD USE ONLY City 1- 4932 5151 5110 Pacific Avenue I Pacific Avenue Pacific Avenue STOCKTON CLP,—coo to S I OCK I ON I STOCKTON _ L e P, 2. 3. 4. ❑ Unit 2H 5. (],Unit 3 6. .�/ 7.N/un N/unit4 8. ErTE MITIGATION 9. Unit 5 10. Specific Date Range of Information Requested: From_ ALL to ENVIRONMENTAL HEALTH DEPARTMENT FILES X UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑MEDICAL WASTE FACILITY iX SOLID WASTE FACILITYIVEHICLE XOTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT IX WASTE TIRE 15� UNDERGROUND TANK (MONITORING/REMOVAL) ❑ FOOD FACILITY ❑ DAIRY 1A ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL [ WASTEWATER TREATMENT PLANT HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS f TIERED PERMITTED FACILITY ❑ POOLISPA LAND USE APPLICATION SITES U TATTOOIBODY PIERCING 13d COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above Address ranges will not be accepted. Applications received after 3:00 pm will be processed the next business day. 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. 3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 4. Any file riot returned in the same condition as released will be reorganized'by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $130 deposit prior to review. ***BOXED AREA - EHD USE ONLY*** 711115