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r <br />APPLICANT: <br />ADDRESS: <br />PHONE (1): <br />*SAN JOAQUIN COUNTY • <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />1: (209) 468-3420 Faz: (209) 464-0138 Web: www.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />PHONE <br />EHD LOG NUMBER <br />a <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/rCYECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT l�i')'�( �%(il/La, i( DATE fya//sj <br />Electronic Information: ❑ List ❑ Map -Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />it1 <br />1. <br />2. <br />6. <br />r190. <br />Street# Street Name City <br />10858 Trinity Parkway, Stockton, CA (Chevron Station) <br />10940 Trinity Parkway, Stockton, CA (Fresh Cleaners) <br />Trinity Parkway, Stockton, CAa. 2615 W Grant Line Road, Tracy, CA (Chevron) <br />2785 W Grant Line Road, Tracy, CA (America's Tire) <br />2481 Naglee Road, Tracy, CA <br />2440 Daniels Street, Manteca, CA (Costco Gas) <br />2120 Daniels Street, Man <br />An/ I <br />hM <br />tts <br />rN ❑ud11210318 <br />NFF <br />12-11Jnit4 <br />❑ Unit <br />rYAt <br />Nv tSi Q <br />fa1k \C#0!5. <br />1P ❑ Unit 6 <br />a <br />7 <br />(" <br />Specific Date Range of Infor"ion Requested: From to �t <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES 7 <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILITYIVEHICLE <br />[—HAZARDOUS <br />OTHER CLEANUP SITE (NON -LOP) El HOUSING ABATEMENT ❑ WASTETIRE <br />UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ FOOD FACILITY El DAIRY <br />ABOVEGROUNDTANK ❑ CHICKEN RANCHI DOG KENNEL E:1WASTEWATER TREATMENT PLANT <br />WASTEIHAZARDOUS MATERIALS F]MOTELIHOTEL E]PUMPER TRUCKIYARD/CHEMICAL TOILETS <br />TIERED PERMITTED FACILITY [:LP00LISPA F]LAND USE APPLICATION SITES <br />F1_ <br />TATTOOIBODY PIERCING COMPLAINTIRESPONSE RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-6:00PM (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 />Coin OO 7137 ( M1 { tc r 14140 Awle S , toJ4eX Slob I Ek reiijk& (a►* Vki Cv <br />dM 4k• Cv 1 i5 )n L% T Litt Lor (OI65'6-r?, 1 IK <br />rkyvikel llST fit Gor at4tio DaA;el ).G( Mari I ISR of �ia){ C - <br />0 Records provided by Staff -PPR Complete. Staff Name: <br />-Aw <br />7z. <br />