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07/14/2016 -0400 FAXCOM ANYWLihFLE PAUL; 3 0? 3 <br />d, <br />DATER 9t/ED EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />I, a ENVIRONMENTAL HEALTH DEPARTMENT <br />iWR0Nii1ENVLHEAL1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />E I�j_ ne: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />� } <br />(�E��i6 E fSE�:t�E��� ' <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Amanda Benbow <br />ADDRESS: 3400 Douglas Blvd Suite 200 <br />PHONE ('i): ((916) 472-2870 PHOEBE (2): <br />BUSINESS/AGENCY: PM Environmental Inc. <br />CITY/STATE/ZIP: Roseville, CA 95661 <br />FACSIMILE: <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 app . tment date and time to review the requested records. <br />❑ CHECK BOX TO EXPEDITE REQUEST- $1 0 FEE H OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGhlATURE OF APPLIC'ANTT DATE July 14, 2016 <br />Electronic Information: ❑ List ❑ flap — Description: <br />FILE t;DDRESS <br />EHD USE ONLY <br />❑ Unit 1 <br />Street# Street Name City <br />!. <br />4445 <br />North Pershing Ave <br />Stockton <br />Q <br />nit 2 <br />2• 4444 North Pershing Ave Stockton <br />S. <br />4501 <br />North Pershing Ave <br />Stockton�I`�'�hi�'' <br />�y� j <br />` /o <br />Ole H'Inl / <br />�� '�! 11 �Y <br />® Unit 3 <br />4. 4555 North Pershing Ave Stockton" <br />5. <br />7. <br />S. <br />❑ Unit 5 <br />9. <br />❑ Unit 6 <br />10. <br />Specific Date Range of Information Requested: From <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />❑X UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WAST E FACILrrY <br />❑ OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT <br />© UNDERGROUND TANK (MONITORING/REMOVAL) ❑ FOOD FACILITY <br />® ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL <br />X❑ HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTELIHOTEL <br />❑ TIERED PERMITTED FACILITY ❑ POOLISPA <br />❑ TATTOOIBODY PIERCING ❑ COMPLAINTIRESPONSE RECORDS <br />to <br />❑ SOLID WASTE FACILITY [VEHICLE <br />❑ WASTE TIRE <br />❑ DAIRY <br />❑ WASTEWATER TREATMENT PLANT <br />❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />❑ LAND USE APPLICATION SITES <br />❑ 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 num ber 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 />(�VlittJLCI�►'I,t"�# (;fll�YlG1 iQ(?L z rnllf)-m.com <br />❑ Records provided by Staff -PPR Complete. Staff Name: <br />Received Time Jul. 14. 201E 2:58PM No.0974 <br />�5T <br />