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SITE INFORMATION AND CORRESPONDENCE FILE 3
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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COUNTRY CLUB
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2575
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2900 - Site Mitigation Program
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PR0541989
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SITE INFORMATION AND CORRESPONDENCE FILE 3
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Last modified
6/21/2019 5:29:52 PM
Creation date
6/21/2019 3:23:03 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
FileName_PostFix
FILE 3
RECORD_ID
PR0541989
PE
2950
FACILITY_ID
FA0024100
FACILITY_NAME
COUNTRY CLUB VALERO
STREET_NUMBER
2575
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12302012
CURRENT_STATUS
01
SITE_LOCATION
2575 COUNTRY CLUB BLVD
P_LOCATION
01
QC Status
Approved
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EHD - Public
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rr>r5' UPM Bad"^^. s Environmental. , Inc 51 ' 349098 r . i <br /> LASE RECEIVED SAN JOAQUIN COUNTY EHO LOC NUMBER <br /> 27 2015 ENVIRONMENTAL HEALTH DEPARTMENT � ® <br /> ENVIRONMENTALF�V T�1� 1868 East Hazelton Avenue , Stockton , CA 95205-6232 <br /> PERMITISERVICt �p"one : (209} 468-3420 Fax : (208) 4640138 Web: www. ejgov,orglehd DV <br /> (IPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: SAM LorJ6*t BUSINESS/AGENCY,. %AASIcAS P1yitbr.lMl6AITAL• 1trL , <br /> ADDRESS: 655 I2TN ?TRErT i SyiTE 1216 \ ' .CITY/STATEMP : dAy.6Atjp wA 9Li6p + <br /> PHONE (1 ) 1 ASko� 6Kq PHONE (2) N (St; ) Lo1 Ll '1Cil FACSIMILE: 'al { W � 01 � <br /> Please allow 10 husiness 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 /> ❑ CHECKBOX TO EXPEDITE REOU - $130 FEE (CASOR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE t I2 6 I IS <br /> Electronic Information: [] List ❑ Map — Descriptlon : <br /> FILE ADDRESS END USE ONLY <br /> street s - — — — Street Name City f <br /> 1m tf) <br /> 2. wrt� Unit v <br /> 3. %Mel <br /> Ak <br /> e. --- - 'unit 4 <br /> 7. <br /> a• _ Unit e <br /> 9= <br /> Spseltic Data Range of Informatifn Requested : From _ to <br /> ENVIRONMENTAL HEALTH DEPARTMENTFILMS <br /> 00,DEROROUNDTANK (UST) CLEANUP SITE (LCP) ®11AEDICAL WASTE FACILITY ®SPLID WASTE FACIURYIVEHICLE <br /> *E1Ftt0;OU1 <br /> ICLEANUPSRE (NOn!•LOP) ® HOUBINO ABAT€HENT ABTE TIRE <br /> D TANK (MONiTORINWREMOVAL) ® FOOD FACILrr1' ❑ AIRY <br /> VEOROUNDTANK ® CHIGKENRANCHIDOB KENNEL ASTEwATERTREATMENTPLA14T <br /> IL��1,'F'CjA7ARDOUSWASTE1HAZARpNuSMATERIALS ❑ MOTEUNOTEL LIMPER TRUCKIYARDICHEMICALT01LET8 <br /> IERED PERMITTED FACILITY ❑ POOLISPA (-AND USE APPLICAT90N SITES . <br /> ❑ TATT001000Y PIERCING ® COMPLAINTIRESPON8 € RECORDS ❑ OTHER. (PLEASE SPE61I Y) <br /> VVELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FROPAV 8 : 00 AM1 0ewpm (EXCLUDIHO HOL1DAVO) <br /> 1n jqVAggpWftA In the space above. Select the type(a) of files from the (lest above by checking the appropriate <br /> boz(es)� At least oria file type MUST be selected. Fax to (20 ) 489-01gfi ar msall to the oggEMajndlceted above. Address <br /> rangia will not be accepted. Applleatione received atter 3 :00 pm will be proosseed the next buslnaes day. <br /> 2. For assistance In Idaritlfying the nature and Content of EHD records , please contact END at the number noted above, <br /> l 3. The END will notify the applicant 11 any EHD fllea exist. An appointment for review will be confirmed approxlmatsly tan (10) <br /> l days attar racelKfi of applluatlon. The f11ee will 4e held for a maximum of five business days for review, Appointments <br /> I , should be scheduled accordingly, <br /> 4. Any file not returned In the same oondltlon me released will be reorganized by END ataff at the expense of the applicant <br /> Future flle reAwr :r by ?ha oame applicant may requlry a 5130 deposit prior to review, .**DOXE Q AREA - EHD UBE ONLY•*° <br /> Q Records Provided by Staff- PPR t'tirnplet:e .. >tfatt Name : <br /> aiReceived Time"Jan , 26 $ 2014 : 54PM=N_D ,. 195-8 �` <br />
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