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EHD LOG NUMBER <br /> DATE RYCED <br /> SAN a1OAQUIN COUNTY <br /> ,J ENVIRONMENTAL HEALTH DEPARTMENT <br /> 95205-6232 <br /> � 1868 East Hazelton Avenue, Stockton, CA <br /> I <br /> Te .1, (209) 468-3420 Faz: (209) 464-0138 Web: www.sjgov.org/ehd <br /> a, <br /> !� PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT•;k o C-c', ( Lull 1+ 11n(",� BUSINESS/AGENCY: <br /> ADDRESS: •/�. � � �� c�J 'i (�� CITYISTATEIZIP: '/1) r,-5 X1'1 <br /> PHONE ( )1 : r <br /> PHONE (2):/•,pc�u�1}/1'l(1�:tEil )�'' tl`FAC�SIMILE: <br /> 1l� <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 CH,E'CK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT J,/': ) 1/�,�%GV`� ''� l DATE 6`�// <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) ❑ Unit 2 ; <br /> 10318 Trinity Parkway, Stockton, CA '`` <br /> 4� 2615 W Grant Line Road, Tracy, CA (Chevron) I 5 v�t-Jr�l/J .❑u it 3 <br /> 5. 2785 W Grant Line Road, Tracy, CA (America's Tire) Iv�F <br /> t762481 Na lee Road, Trac CA ^� .p'�init4 <br /> 2440 Daniels Street, Manteca, CA (Costco Gas) I ►^ ❑ Unit 5 <br /> 2120 Daniels Street, Mang, r �tf &.1k \At ❑ Unit 6 <br /> Specific Date Range of Infor ion Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> 'OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) <br /> F]FOOD FACILITY El DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> 1 AZARDOUSWASTEIHAZARDOUSMATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING KlcOMPLAINTIRESPONSE 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 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 /> CoN► 1'�,� ��7237 t���� .( 1� r z4Wv pu�la�• c�d'�e�5106 <br /> MPA�Cor (Okq CGS 77- <br /> vikel Gor <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> Warn+r+a <br />