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DATNI D • EHD LOG NUMBER <br /> / SAN JOAQUIN COUNTY <br /> 11 ENVIRONMENTAL HEALTH DEPARTMENT <br /> /,'; 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 68-3420 Fax: 209 464-0138 Web: www.sjgov.org/ehd I <br /> 1 Tel hone: (209) 4 ( ) <br /> ti PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANTP(l-C.Cl,, 1 Y4n,C�!o�' Ina(" L' BUSINESS/AGENCY: Ci/�� e1' ) ;� <br /> : - <br /> ADDRESS: �� /V c/J4Q(-1L &�.t_ CITY/STATEIZIP`/ • JJ1 ' . (�o <br /> PHONE (1): '� ! PHONE(2): Pctl /1\I1l/t (�)hnlfi FAC WILE: lI/ <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(CAST ORCHECKONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /�,`-y;UV1G1/\' �'' -2 DATE cS/ <br /> Electronic information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City it1 <br /> 1. 10858 Trinity Parkway, Stockton, CA (Chevron Station) r t S u5 ,�a.cb <br /> 2. 10940 Trinity Parkway, Stockton, CA (Fresh Cleaners) ❑Unite <br /> r✓f <br /> 10318 Trinity Parkway, Stockton, CA <br /> 4 2615 W Grant Line Road, Tracy, CA (Chevron) I rnn tr v<ft-vii(JJ�p u 3 <br /> 5. 2785 W Grant Line Road, Tracy, CA(America's Tire) k/F <br /> 6• 2481 Naglee Road, Tracy, CA \`^� �init4 <br /> 2440 Daniels Street, Manteca, CA (Costco Gas) S '" u5t-u htb <br /> �� �^ ❑unit s <br /> $ 2120 Daniels Street, Man t q <br /> 9. <br /> 10. a ❑ Unit6 <br /> Specific Date Range of Inforrhaltibn Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYlVEHICLE <br /> 'OTHER CLEANUP SITE(Nom-LOP) 171 HOUSING ABATEMENT WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY E]DAIRY <br /> ABOVEGROUNDTANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATERTMATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL E]PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY _❑-POOLISPA [jLAND USE APPLICATION SITES <br /> ❑TATfOO1BODY 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 /> (q,,,l vo�7137 i .M I"'S'C � Ic f lt}Nt) 4ult Nv`de,),5106 �E ��rw � vW 7z• <br /> CO L7C7 3(C;"5ig 1.t k z due far I t7�i*�!b Ci'Ml K <br /> oi�e♦ LJIST 1- t (*.- 'DKK OgI4,6 -k '-t&14 M'A Ll•r_R Jl 0+ 543 -Ci«i� c <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> "w,=r.._. aR101114 <br />