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DATE RECEIVED <br />0 <br />SAN JOAQUIN COUNTY <br />R"'AECEIVED ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />j a pa Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />J6Yf.S 1 .3 21,,,9 <br />PUBLIC RECORDS RELEASE APPLICATION <br />PERMITtSEl ` fMMY WOODS <br />APPLICANT: <br />ADDRESS: 902 INDUSTRIAL WAY <br />PHONE (1): 209-367-3701 _ PHONE (2): <br />BUSINESS/AGENCY: <br />EHD LOG NUMBER <br />q q <br />F <br />CITY/STATE/ZIP: LODI, CA 95240 <br />N <br />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 - $130 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT TKWOODS(a),TERRACON.COM DATE 01/12/2016 <br />Electronic Information: ❑ List ❑ Map — Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />Street # <br />Street Name <br />City <br />1• <br />6484 N. WAVERLY ROAD LINDEN <br />G, ❑ Unit <br />2- <br />8020 N. WAVERLY ROAD LINDEN <br />3. <br />� <br />a6nit 2 <br />4. <br />❑,Unit 2H <br />5.(7c�;(f <br />ElUnit 3 <br />S' <br />7. <br />f <br />t � <br />)'U .it 4 <br />8. <br />' <br />�0 SITE MITIGATION <br />:rC>l'$� O'lJnitS <br />10. <br />m(/tJ <br />UC►�� <br />Specific Date Range of Information Requested: From V to 02) cc — <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />❑ UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY Z SOLID WASTE FACILITYNEHICLE <br />Q OTHER CLEANUP SITE (NON -LOP) Q HOUSING ABATEMENT 21WASTE TIRE <br />Q UNDERGROUND TANK (MONITORING/REMOVAL) ❑ FOOD FACILITY ❑ DAIRY <br />7 ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />❑ HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCKNARD/CHEMICAL TOILETS <br />/❑ TIERED PERMITTED FACILITY ❑ POOLISPA Z LAND USE APPLICATION SITES <br />❑ TATTOOIBODY PIERCING ❑ COMPLAINT/RESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) Well and Septic <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING forI 1 st address <br />on <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 H 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 />❑ Records provided by Staff -PPR Complete. Staff Name: I <br />EHD 48-06 7/1115 <br />