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�sT- go" 0 • <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> RECEIVEDENVIRONMENTAL HEALTH DEPARTMENT Lhak <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 VIX"'01 <br /> ? ) JAN Z fr hone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> EnmRoNmENTA.HEA&BLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: GODS BUSINESS/AGENCY: NOA/TERRACON <br /> ADDRESS: 902 INDUSTRIAL WAY CITY/STATE/ZIP:_LODI, CA 95240 <br /> PHONE(1): 209-367-3701 _ PHONE(2): 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().TERRACON.COM DATE 01/21/2016 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS <br /> Street# Street Name City EHD USE ONLY <br /> 1. 2510 I North California Street ( Stockton <br /> 2. 2102 North California Street e"5 ptwkl <br /> 3. 1800 North California Street I �ccP ; 'unit 2 <br /> 4. 523 EHarding NIj t2H <br /> 5. 1506 North California Street <br /> 6. 1546 1 North California Street —' LVUnit 3 <br /> k=+ <br /> 7. 49 I West Yokuts I nit 4 <br /> 8. 3132 West March Lane Lra <br /> SITE MITIGATION <br /> 9. 424 Maple Street <br /> 10. 430 Maple Street I CT 1 nit 5 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> V1 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Z MEDICAL WASTE FACILITY SOLID WASTE FACILITYIVEHICLE <br /> Q OTHER CLEANUP SITE(NON-LOP) Q HOUSING ABATEMENT .WASTE TIRE <br /> Q UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> 0 ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL .WASTEWATER TREATMENT PLANT <br /> ❑HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA Z LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING COMPLAINT/RESPONSE RECORDS Z OTHER(PLEASE SPECIFY)Well and Septic <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING 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(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 if 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 /> y <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 46-06 <br /> 711115 <br />