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DAT" E RECEIVED <br />Telep <br />ISSAN JOAQUIN COUNTY 0 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-62.32 <br />one: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov,orglehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />EHD LOG NUMBER <br />APPLICANT:_ P C (!0, f )Af 'A i CMe'l, BUSINESSIAGENGY: EA <br />ADDRESS: /, F �' C1TYISTATEIZIP:/ <br />_ f tlY(1 <br />PHONE (1): 7691 R � "'�j J %!� PHONE (2):I <br />L;C•!) f�'lf�ldiE i FACS1MILE: <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 %.(,')"tdr� V'rL'�, DATE <br />Electronic Information: ❑ List ❑ Map —Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />it 1 <br />1. <br />Street # Street Name City <br />10858 Trinity Parkway, Stockton, CA (Chevron Station) <br />2. <br />10940 Trinity Parkway, Stockton, CA (Fresh Cleaners) <br />El Unit 2 <br />lee QR vfik_ A100 .Cl Unit <br />10318 Trinity Parkway, Stockton, CA <br />(4)' 2615 W Grant bine Road, Tracy, CA (Chevron) <br />5. <br />2785 W Grant Line Road, Tracy, CA (America's Tire) <br />k°c- <br />�• <br />2481 Naglee Road, Tracy, CA <br />'tom '124 ita <br />• <br />2440 Daniels Street, Manteca, CA (Costco Gas) <br />g <br />9. <br />2120 Daniels Street, Monte_ <br />�r <br />I '" o Units <br />�� We ILD, <br />f-- <br />Unit S <br />10. <br />i- <br />Specific Date Range of lnforrfiatiorRequested: From to ,- <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (1ST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILITYIVEHICLE <br />'OTHER CLEANUP SITE (NON -LOP) F]HOUSING ABATEMENT ❑ WASTE TIRE <br />UNDERGROUND TANK (MONITORINGIREMOVAL) F1FOOD FACILITY Ll DAIRY <br />ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />HAZARDOUS WASTEIHAZARUOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICALTOILETS <br />❑ TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />Ll TATTOOIBODY PIERCING XCOMPLAINTIRESPONSE 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 />00V72_57 1440 baa,�4 , C04 -w Sob a E SOL LA+ o(X) <br />>r'4kel U. TQL &,r a � Duerr �r I I�I ft , a +� i �r ) " <br />0 Records provided by Staff -PPR Complete. Staff Name: <br />- 10) <br />77. <br />