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DATE NI D \ . EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> Sl1'1 ENVIRONMENTAL HEALTH DEPARTMENT <br /> j �� 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> I Tel phone: (209) 468-3420 Fax: (209) 464-0138 Web: wvvw.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ) BUSINESS/AGENCY: <br /> ADDRESS: /4'-;u2 /a d y4Q-1' &"t— CITY/STATE/ZIP: I�ly� C? <br /> PHONE(1): C) �U! PHONE(2):�Pl'11�(Y�I�L{(.�(C�)W*F C MILE: J <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(CAS/y O,R�C/ryECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �/ 11(iti�IG)/ r LC DATE 5 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City it 1 <br /> 1. 10858 Trinity Parkway, Stockton, CA (Chevron Station) r t `� u5 y/utGb <br /> 216. <br /> 10940 Trinity Parkway, Stockton, CA (Fresh Cleaners) �n +� ❑Unit 2 <br /> 10318 Trinity Parkway, Stockton, CA t <br /> ' 2615 W Grant Line Road, Tracy, CA (Chevron) -VUU3 � unit3 <br /> 2785 W Grant Line Road, Tracy, CA (America's Tire) ►vrF2481 Naglee Road, Tracy, CA tt"� nita <br /> 2440 Daniels Street, Manteca, CA (Costco Gas) S h ayt-u th <br /> C� ► ❑ Unfit <br /> 8. 2120 Daniels Street, Man �� <br /> 9. �1� conuJ. <br /> 10 a ❑ Unit <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 /> OTHER CLEANUP SITE(Nom-LOP) ❑HOUSING ABATEMENT E]WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATERTREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> F1 TIERED PERMITTED FACILITY ❑_POOLISPA LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING �'`�'�(COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(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 /> horn 00 7257 �1�5T ( tom r]t}Nu Awle rodae i3iob IE (� cwt Quo 7�. <br /> f,9rt k Co 113 i5 1n (mT bite for lobsY7-ri`Ml K <br /> oike1 UST 4F,, (or aHw Da�;e! t �I +neR&: d 0 i�iTia){ C <br /> 0 Records provided by Staff-PPR Complete. Staff Name: <br />