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2900 - Site Mitigation Program
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PR0542421
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
6/21/2019 12:25:09 PM
Creation date
6/21/2019 10:07:32 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0542421
PE
2950
FACILITY_ID
FA0024377
FACILITY_NAME
COUNTRY CLUB BLVD/295950
STREET_NUMBER
1876
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12319101
CURRENT_STATUS
01
SITE_LOCATION
1876 COUNTRY CLUB BLVD
P_LOCATION
01
QC Status
Approved
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EHD - Public
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04l30Y2003 09:42 FAX 209 9984621 <br /> r <br /> DATE REcElvp <br /> a0U2,001 <br /> e G I [--.� ( EFSo"x-um-ER% r-' AN JOUIN COUNTYPUBLIC HEALTH SERWCES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Q PR 3 2003 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOGKTON CA 95202 <br /> eNV#r. (zns)468-U20'uII ,T. :�REAL UBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT � /"I" �-- BUSINESSIAGENCY Ac' e <br /> ADDRESS i �-�:2 +ts ► �-r S �— <br /> PHONE- ;���~ /3r7S FACSIMILE d6 n <br /> TENTATIVE•APPOINTMENT DA'T'E TIME <br /> .(Pleas*give 7 to 10 businesr days from date of application submiGIj �. l S� <br /> CHECK BOX TQ EXPEDITE REQUEST•$87.00 FEE MQUEST PROCESSED IN 3 SUSINF35 PATS <br /> i '�" `� <br /> SIGNATURE OF APPLICANT « OAT` _ c7 #a , <br /> FILE ADDRESS THIS SIDE:EHD S i•AFF USI-ONLY <br /> PROGRF.M f:LEli,ENlS GGBARCH <br /> /876. Cov,,+r Cfv& -41v4 . i _ <br /> 01911 ot,^ r (vL <br /> 10 <br /> l,� 4�lJr .�r cr�6 �Iy r <br /> /Yd 3 �# ovn{-� Club r'31✓�• � �"-- i <br /> - <br /> 70 J�'11 u., cr46 3►+�� <br /> C 0-*N -r C l vb 1✓1. 10 <br /> rvr-I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> -O'uNDERGIROUND TANK(UST)CLEANUP SITE(LOP) C7 HOUSING ABATEMENT 0 rLID WA.371:FAiCILRY <br /> 19rOTHER CLFANUP SITE(NON-LOP) ❑ FOOD FACILITY WASTE VEHICLE <br /> •X (NDERGROUND TANK(MONrroFU VGIREMOVAL) . ❑ pOG KENNEL ❑ DIX( <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ cwcKmi RANCH I] PKG TREATMENT PLANT <br /> ❑ TIERED PEkMETTED FACILrTY Ci Mpl'ELri OTEL 0 PUMPERTRUCKrYAROICHEM TOILE 32 <br /> ❑ TATTOWBODY PEIRCING ❑ POOLJSpAq ❑1AND USE APPLICAInON SITES <br /> O MFDiCAL,WASTE FACILn'Y ❑ PUBLIC WATER SYSTEM U 07HI:R(PI..EASS SPECIFY ABOVE) <br /> 1. Lt up to ten addresses in the space above. Select the type(S)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. ELx i:4 a09) 46d-A L or nla'I to-Al A E <br /> "address indicated above. . ; <br /> 2. EHD will notify the applicant if any EHD files +exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days after rocelpt of application. The furs <br /> Will be held for a maximum of five business <br /> days for review, Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on b EHI3 staff may not be immediatr;i available for rei+iew. Anew <br /> Y Y Y <br /> application may be submitted when the rile is available. f <br /> 4. Any file not returned in the same condition as released will be reorganized'by END staff at the expense <br /> of the applicant. Future file reviews by the same appiicaht may requirEe a $87.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed.the next busine:;s day. <br /> li <br /> CONFIRMED APP01I TMENT DATE TIME <br /> DATE CONFIRMED PHONY FAX INITIAL!; <br /> REVIEWEDi YES NO REVIEW DATE <br /> ,: I <br />
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