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DAT" E RECEIVED EHD LOG NUMBER <br /> \ SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> _ 1 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: `_ ��(✓C Cry f G'I il'1 r 1`�CAC ' <br /> BUSINESS/AGENCY: ( :�/��� <br /> ADDRESS: r' : � !� � '' �� _ ( CITY/STATE/ZIP: T j c5r)0 <br /> PHONE 1 .'�. ( ? ( )�`•p('114!}rl' (1�:�C f� }�''� FAC�SIMILE: <br /> ( ); �j 1 j /�� PHONE 2 t <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 J.%: I^�tf�.�Ili� `4 I -�'. DATE . <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) <br /> 2. 10940 Trinity Parkway, Stockton, CA (Fresh Cleaners) c hm ❑ Unit 2 ; <br /> 10318 Trinity Parkway, Stockton, CA <br /> 3 4. 2615 W Grant Line Road, Tracy, CA (Chevron) IMMv,c/J Q Unit <br /> i <br /> 5. 2785.W Grant Line Road, Tracy, CA (America's Tire) AO�� <br /> 6. 2481 Naglee Road, Tracy, CA p1(iit4 <br /> • 2440 Daniels Street, Manteca, CA (Costco Gas) <br /> c� 8• 2120 Daniels Street, Mante I e� I ❑ Units <br /> y 9. - �""rcc 6,'\k \ <br /> o� <br /> 10. } (- ❑ Unit 6 <br /> Specific Date Range of Infer' ion Requested: From to <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 <br /> [j WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY <br /> [j DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUSWASTEIH4ZARDOUSMATERIALS F1MOTELIHOTEL ❑PUMPER TRUCK/YARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> F]TATTOOMODY PIERCING COMPLAINT/RESPONSE 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$130 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** <br /> �onn I`�n ��7237 ! t„��`C tt ✓ -440 puAlt�a. Cov`,�CJ•SI®6 jC (oL LA$ LOW3 77-. <br /> (,9r� k` Q2 C9(2 3( � l5 �n L&57 Pie- <br /> Cnr Ia7rG1;tTi`�i <br /> wikel QST �.IC (,r aHV( DQ^Sea A� 1&( �� �1-►�ke1s _(005*(8 �rw)� C <br /> ELI Records provided by Staff-PPR Complete.Staff Name: <br />