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SITE INFORMATION AND CORRESPONDENCE FILE 1
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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COUNTRY CLUB
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2103
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3500 - Local Oversight Program
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PR0544591
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SITE INFORMATION AND CORRESPONDENCE FILE 1
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Last modified
6/21/2019 2:38:17 PM
Creation date
6/21/2019 11:32:02 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
FileName_PostFix
FILE 1
RECORD_ID
PR0544591
PE
3526
FACILITY_ID
FA0005220
FACILITY_NAME
CHEVRON #9-4054
STREET_NUMBER
2103
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12308029
CURRENT_STATUS
02
SITE_LOCATION
2103 COUNTRY CLUB BLVD
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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10/13/2002 X3.37 17078773276 ANTON GEOLOGICAL PAGE 02/02 <br /> ... ... j9-Et4=7-C'/Ui l :'�SHf •' lu :trw'Irrri?C/U r.Nl <br /> 1 COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR 0 <br /> STOCICfON CA 95207. / <br /> O (209)468-3420 <br /> II PUBLIC RECORDS RELEASE APPLICATIO nim <br /> APPLICANT Ehl IVTCl t �llc)' f_ \'� ��-, - <br /> /�� ��OIU91NgC551�A{GZCN�C7Y I-_-(`\lUJthry+ <br /> aDDFE55_n D. QC3K 37Jf Lif�f�1 (�./-r fS'IJ C-. ' OrT14 2002 <br /> 7b�-W?- 327Fr ' <br /> HONs �r''n--csnnlMclLnL7o-2-S-77 - 3076 <br /> u-77 �S 77 3276 ,� '4�lMft <br /> TP -IVE'APPOINTMi'-NT DATI° �—;n- ,I� 17 <br /> /C/t.+Z <br /> CTIME moi:(7U/ MMIT/SERVICES <br /> (Please�eo.c T to in ss de s n dal applies ' n submllWn <br /> CHECK DOX TO,GXPEDITE REQurST-Sa? — C�5 DUs ESS DAYS <br /> 3,IGNA7URE OF APPLICANT DATE /U /3 02- <br /> FILE ADDREP "THIS$IDL EHD STAFF USU ONLY <br /> I PROOKAM CLGMENTS SEARCH <br /> 103 Tadsci>+-1 <br /> Z/S 1 ! ,.rT•fY -row p <br /> I <br /> i <br /> I <br /> i <br /> • ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDGjRGROUNO TANK(UST)CLEANUP SITE CLOP) O HOUSING AOATEMENT O SOLID WASTE FAC&IrY <br /> 9 O7NE CLEANUP SITE(NON-LOP) CI FOOD FACILITY Q 50LID WASTE VEHICLE <br /> UND GROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> DOV3 WASTE GENGRATOR O CHICKEN RANCH O PI<GTREATMENTPLANY <br /> ] TIERUD PIERMITT40 PkCILrrY 0 MOTEL/HbTL'L 0 PUMPER TRUCWYARD/GHEb1 TOILETS <br /> 7 TATTQOIDODY PWRCING 0 POOUSPA ❑ LAND USE APPLIEATION SRBS <br /> ZI MED1eAL WASTR.FACILITY D PUULIC WATER SY5YEM 0 OTHER IPLEA51ii SPECIFY AOOVE) <br /> 1. List up 1:0 ten addrerscs in the space above. Select the types) of files from the list above by ehockin7 <br /> the approp iate box(es); At )east one file type MUST be selected, F_ax to (7091 464-0178 or mail Ili thy <br /> address indicated above. <br /> 2 1 EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> 1 approximately five business days but no later than tan (10) days alter receipt of application.-The files <br /> will be held (or a maximu(ii of five business days for review. Appointments should be Scheduled <br /> j accordingly, <br /> I A filo chat is actively being!worked on by EHD staff may not be immediately available for review- A new <br /> i application i'1'Iay be Submitted when the file IS available. <br /> I. Any file noVrcturned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the. applicant, Fu[40 Ylle reviews by the same applicant may require a$07.00 deposit prior to review, <br /> i- <br /> *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> >: Applications received after 3:00 Pm will be processed the next business day. <br /> ;,ONFI�RMED APPOINTMENT DATE TIME <br /> SATE CIONFIFtMED PHONE FAX INITIALS <br /> I <br /> 2EVl! N1ED YES No RSVIHW n4rF 70Th P.01 <br /> N MIM <br /> r <br /> s <br />
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