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DATE RECEIVED � <br /><_ Te <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />one: (209) 468-3420 Faz: (209) 464-0138 Web: www.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />EHD LOG NUMBER <br />S ,A <br />APPLICANT:�(,LAf,,r Z�ti7_ IY�l< BUSINESS/AGENCY: L_.M j, �._.) <br />. � 1 <br />ADDRESS: +'4 j '- � C�'L CITY/STATE/ZIP: '� ce$o,� �i �� <br />r.� <br />�� '(),�c^crG7�11�fY1tit(1)�tiu/FACSIMILE: l�f <br />PHONE (1): �� " t ` �I��fPHONE 2 <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.CC ECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS <br />SE ONLY <br />it 1 <br />Street # Street Name City <br />� <br />1. 10858 Trinity Parkway, Stockton, CA (Chevron Station)6WEHD <br />2. <br />10940 Trinity Parkway, Stockton, CA (Fresh Cleaners) <br />❑ unitz <br />u <br />10318 Trinity Parkway, Stockton, CA <br />4" <br />2615 W Grant Line Road, Tracy, CA (Chevron) <br />°ee <br />S V�, 7, x,60_0 3 <br />kA- <br />S. 2785 W Grant Line Road, Tracy, CA (America's Tire) <br />6. <br />2481 Naglee Road, Tracy, CA <br />� <br />.0'Unit4 <br />• 2440 Daniels Street, Manteca, CA (CostcoLGas)f8• <br />212.0 Daniels Street, Mante <br />❑ Unit5 <br />e� t o, <br />s. <br />4 <br />VV ❑ Unit 6 <br />�Yt10. <br />i1 <br />Specific Date Range of Inforrhafion Requested: From - to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILITYIVEHICLE <br />OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE <br />UNDERGROUND TANK (MONITORINGIREMOVAL) ❑FOOD FACILITY ❑ DAIRY <br />ABOVEGROUND TANK- ❑ CHICKEN RANCH/ DOG KENNEL E] WASTEWATER TREATMENT PLANT <br />HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEMICALTOILETS <br />❑ TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ TATTOOIBODY PIERCING Klc6MPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <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 END 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 rPviPws by the same aoolicant may require a $130 deposit prior to review. ***BOXED AREA - EHD USE ONLY*** <br />Co►,� l`,n W_�-57 , th (AK� Alt -_ ,r 2t{.40 Aa.,1e. � • j44e, 8(06 E f <br />(0M 1kk`11 CC2 `Ir� pt iy)�e( �5i pte ('f 1 -( L <br />IVVike � ��� -I(C P dLOI� �JQ°�iCA '� I�115 �PBie6/� Ld•1LiL� Gk K ON ArvIA °.a VIA 00- <br />D <br />-❑ Records provided by Staff -PPR Complete. Staff Name: <br />4%6b <br />77. <br />