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DAT' E RECEIVED <br />1 r1 1 <br />& P?-, <br />1P 17 <br />Tff <br />ell <br />p <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />hone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />EHD LOG NUMBER <br />T BUSINESSIAGENCY: (�JI�(> r APPLICANT:p L(._C�., l ;Lt i1'i I,i"1(hl"' �� <br />ADDRESS: �:: � �� � �'- ���_ CITY/STAjT.EIZIP:7 1 C5r)() � <br />PHONE (1): PHONE (2): r �� ' /1�t1'1tc:Y1)U�FAC`SIMILE:69 <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 OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT f.(,: ') �j;� V�% `'�� Ll DATE <br />Electronic Information: ❑ List ❑ Map — Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />nit 1 <br />Street # Street Name City <br />�"� S <br />1. 10858 Trinity Parkway, Stockton, CA (Chevron Station) <br />2. <br />10940 Trinity Parkway, Stockton, CA (Fresh Cleaners) <br />° ►^�^ <br />�^ El Unit <br />"fes <br />10318 Trinity Parkway, Stockton, CA <br />4. <br />2615 W Grant Line Road, Tracy, CA (Chevron) <br />° <br />��^ '� S�-1lvw� p u it3 <br />5. 2785, W Grant Line Road, Tracy, CA (America's Tire) <br />6. <br />2481 Naglee Road, Tracy, CA <br />'tom <br />Er nit4 <br />�j�-Uj~c� <br />• <br />2440 Daniels Street, Manteca, CA (Costco Gas) <br />8• <br />2120 Daniels Street, Mant- <br />° ~ <br />E] Unit <br />9. <br />-fi"r <br />Pyr <br />k1k \ <br />❑ Unit 6 <br />10. <br />a <br />; <br />{" <br />s <br />Specific Date Range of Infontlation Requested: From "' <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILITYIVEHICLE <br />OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE <br />UNDERGROUND TANK (MONITORING/REMOVAL) F1 FOOD FACILITY ❑DAIRY <br />ABOVEGROUND TANK F] CHICKEN RANCHI DOG KENNEL [j WASTEWATER TREATMENT PLANT <br />HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br />F-1TIEREDPERMITTED FACILITY ❑ POOLISPA ❑LAND USE APPLICATION SITES <br />❑ TATTOOIBODY PIERCING KICOMPLAINTIRESPONSE 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 END 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 />r..a...... L:1.. .....:....... My tke c me nnnrirnnt may rarmire a $130 deposit prior to review. ***BOXED AREA- EHD USE ONLY`** <br />Low k' CO (qD=s i^ L&, -r �uO_ i„r lobs,61f ,A,K <br />�'tkej ��� �� C C� r a"IK INII(� 16 I V1 e �r� <br />❑Records provided by Staff -PPR Complete. Staff Name: <br />-.__._......,.....__ nwai/14 <br />411407 <br />I <br />M <br />