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EHD LOG NUMBER <br /> /DATE E RECEIV�D ...� � <br /> SAN JOAQUIN COUNTY <br /> ( r ,�C ENVIRONMENTAL HEALTH DEPARTMENT <br /> j tv �. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> U I Tel phone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd I <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: EpL7CC� f ?l�r,j1�(Y/1AC'k BUSINESS/AGENCY: <br /> ADDRESS: CITY/STATE/ZIP: -j' <br /> PHONE (1): PHONE (2): <LYY\0dC � CS� MILE: <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 ORFC ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE cS/ <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City it t <br /> 1. 10858 Trinity Parkway, Stockton, CA (Chevron Station) fNr^ 5 k5 ,1n+cb <br /> 2. 10940 Trinity Parkway, Stockton, CA (Fresh Cleaners) ( ten r~ ❑unit 2 <br /> 10318 Trinity Parkway, Stockton, CA14 , <br /> 4. 2615 W Grant Line Road, Tracy, CA (Chevron) I M 's S �-Jar1� ,p u 3 i <br /> 5. 2785 W Grant Line Road, Tracy, CA (America's Tire) N« <br /> 5- 2481 Naglee Road, Tracy, CA tt^� nit4 <br /> 2440 Daniels Street, Manteca, CA (Costco Gas) S '' k5t-u6th <br /> { $• 2120 Daniels Street, Mant I Nv e q ❑ Unit <br /> 5 <br /> 9. ca- <br /> firc 411 �(AAuJ. ' <br /> 10. a , a ❑ Unit 6 <br /> Specific Date Range of Infor ion Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> 4--?j1HAZARDOUS <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUNDTANK(MONITORINGIREMOVAL) ❑FOOD FACILITY DAIRY <br /> 01, <br /> BOVEGROUNDTANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> TIERED PERMITTED FACILITY ❑/POOLISPA [:]LAND USE APPLICATION SITES <br /> F1TATTOOIBODY PIERCING y�I COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(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 EHD 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 reviews by the same applicant may require a $130 deposit prior to review. ***BOXED AREA-EHD USE ONLY**' <br /> LoM 0072-57 .�(`S� ( tom �zyNp An,le - rou`JeJ Sob -.61 Ek Cru �� Ow 77— <br /> (OM LkCO (SW5 i5 in QST �.ilC lb/` 10�5�J�t'/`•nl tC -1^ <br /> oike,1. U. T {,e'- aNK �a�;e1 F )fr l tT .r{ U e Rr1. d Obi�j 1ro,1� Oq c <br /> 0 Records provided by Staff-PPR Complete.Staff Name: <br />