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SITE INFORMATION AND CORRESPONDENCE FILE 1
Environmental Health - Public
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EHD Program Facility Records by Street Name
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COUNTRY CLUB
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2575
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2900 - Site Mitigation Program
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PR0541989
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SITE INFORMATION AND CORRESPONDENCE FILE 1
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Last modified
6/21/2019 5:10:28 PM
Creation date
6/21/2019 3:11:05 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
FileName_PostFix
FILE 1
RECORD_ID
PR0541989
PE
2950
FACILITY_ID
FA0024100
FACILITY_NAME
COUNTRY CLUB VALERO
STREET_NUMBER
2575
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12302012
CURRENT_STATUS
01
SITE_LOCATION
2575 COUNTRY CLUB BLVD
P_LOCATION
01
QC Status
Approved
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7 NUMtltK <br /> Jw �tY <br /> DATE RECEIVED SAN JOAQUIN COUNTY `J/ <br /> ENVIRONMENTAL HEALTH DEPARTM T <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Telepho . ( 9)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> 2005 APR 26 AM 10- :I1 <br /> PUB RECORDS RELEASE APPLICATION <br /> A APPLICANT: k / BUSINESSIAGENCY: ENVIRONMENTAL <br /> "I ADDRESS: / <br /> PHONE(1): T77' Z6Y PHONE(2):&0—' DI— 3z to FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from d to of a lication submittal-'Tentative only-must be confirmed) <br /> C3 CHECK BOX TO EXPEDITE REQU T-$93.0 F ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 US ESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION 0 Unit 1 13 Unit 2 0 Unit 3 0 Unit 4 11 Unit 5 O Unit 6 0 Other(electronic/liststmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> S <br /> treet# Street Name City <br /> k2.11 <br /> 9 r4 [�7d! 3 a <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITYNEHICLE <br /> TNER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 WASTE TIRE <br /> UNDERGROUND TANK(MONRORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> LJ HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTEL/HOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOOIBODY PIERCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses, contact <br /> the EHD. Applications received after 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately ten (10) days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted`when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the <br /> applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br /> END a 42z <br />
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