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LOGNUMBERVIIk <br /> SAN JOA <br /> DAT' eRecelVj D ' Q.UIN COUNTY <br /> AFOO � �; �� <br /> 1 MENTAL HEALTH DEPARTIlIi 0 it <br /> ENVIRON CA 95205-6232 , <br /> t , L' ) . t• 1868 East Hazelton Avenue, Stockton, ' ov.org/ehd <br /> Telephone: www.sjgov.org/ehd <br /> (209) 468-3420 Fax: (209) 464-0138 Web. <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> /I <br /> BUSINESS/AGENCY: 4Z ! '� <br /> APPLICANT:, 1C,CAC:.K y3�7j� <br /> • ) fl/ (� CITYISTATE2IP: !! 1) <br /> ADDRESS: <br /> PHONE (1): 1 �� S I��� PHONE(2):p�, vrn rl�fic ) <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(CASOR�CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE �/ ,�•/ <br /> SIGNATURE OF APPLICANT II 1 �(i VIlU� `` '//��6 F <br /> Electronic Information: ❑ List❑ Map—Description: <br /> EHD USE ONLY <br /> FILE ADDRESS ❑Street Name <br /> Unit1 <br /> City <br /> Street# <br /> 1. 10858 Trinity Parkway, Stockton, CA (Chevron Station) 0`"^ unit z <br /> 2. 10940 Trinity Parkway, Stockton, CA (Fresh Cleaners) <br /> 3. 10318 Trinity Parkway, Stockton, CA <br /> Q Unita ' <br /> d. 2615 W Grant Line Road,Tracy, CA (Chevron) <br /> e. 2785 W Grant Line Road,Tracy, CA (America's Tire) S/tu� o C;ta <br /> 6. 2481 Naglee Road,Tracy, CA I <br /> P "� k <br /> '7• 2440 Daniels Street, Manteca, CA (Costco Gas) I �!� Unit <br /> Jp 8. 2120 Daniels Street, Man <br /> 9. r <br /> ❑Unit 6 <br /> 10. a ; r to <br /> Specific Date Range of Infor ion Requested: From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES SOLID WASTE FACILITYNEHICLE <br /> QWASTETIRE <br /> UMEDICAL WASTE FACILITY NDERGROUND TANK(UST)CLEANUP SITE(LOP) �HOUSING ABATEMENT <br /> 'OTHER CLEANUP SITE(NON-LOP) ❑DAIRY <br /> UNDERGROUND TANK(MONR0 FOOD FACILITY ORINGIREMOVAL) CHICKEN RANCHI DOG KENNEL ❑WASTEWATERTREATMENT PLANT <br /> ABOVEGROUND TANK MOTELIHOTEL ❑PUMPERTRUCKIYARDICHEMICALTOILETS <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS F p00LISPA ❑LAND USE APPLICATION SITES <br /> ❑TIERED PERMITTED FACILITY COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> ❑TATTOOIBODY PIERCING <br /> R REVIEW: MONDAY-FRIDAY 8:00 AM-S:OOPM(EXCLUDING HOLIDAYS <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FO <br /> type( )of files <br /> checking the appropriate <br /> pace <br /> ct <br /> om <br /> 1 box(es)toAt least one fHe type MUST be above.selected. Fax 209s 464-0138ror mail to the addrethe list above ss indicated above. Addressranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> at <br /> number <br /> 2. For assistance in identifying the nature and content of EHD re ordpleas <br /> for reviewtcwille cotconfirmed approxima ely ten(10) <br /> 3. The EHD will notify the applicant if any EHD files exist. An appointment <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. ed will be the <br /> 4 Any file not returned in the same condion as releas <br /> Future file reviews by the same applicant may require a$130 deposit prior oyeview. f BOXED AREA EHD USE ONLY*** <br /> 01 Records provided by Staff-PPR Coanplete: staff Name: eRe „d <br />