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05/09/2016 6:28:41 PM —0400 FAXCOM ANYWHERE <br />DA Ri <br />FECnivEEIVED <br />SAN JOAQUIN COUNTY <br />PAGE 2 OF 2 <br />EHD LOG NUMBER <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />-1NVrRO WEWAL Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/end <br />PERFAIT/SEC <br />`_ PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Amanda Benbowbenbow(cD_pmenv.com BUSINESSIAGENCY: PM Environmental Inc. <br />ADDRESS: 3400 Douolas Blvd Suite 200 <br />PHONE (1): (916) 472-2870 <br />PHONE (2): <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 appointment date and time to review the requested records. <br />❑ CHECK BOX TO EXPEDITE E UEST $ 0 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />Electronic Information: : List ❑ Map —Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />E] Unit 1 <br />Street # <br />Street Nare <br />City <br />1115 <br />West Yosemite Ave <br />Manteca <br />,,,-� �+y� <br />��'r Vim' <br />M C CO©Unit 2 <br />2. 1145 <br />West Yosemite Ave <br />Manteca <br />1048 <br />West Yosemite Ave <br />Manteca <br />N Unit 3 <br />'✓� /li'l <br />4. 1060 <br />West Yosemite Ave <br />Manteca <br />5. 257 <br />West Yosemite Ave <br />Manteca <br />6. 1160 <br />West Center Street <br />Manteca <br />=7. <br />In I <br />1 <br />-�1L �Ii Unit 5 <br />g <br />9. <br />S; i v dei <br />d�> <br />10. <br />Specific Date Range of Information Requested: From earliest available to present <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />0 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILITY/VEHICLE <br />® OTHER CLEANUP SITE (NON -LOP) ❑ HOUSING ABATEMENT ❑ WASTE TIRE <br />❑X UNDERGROUND TANK (M ONITORING1 REMOVAL) ❑ FOOD FACILITY ❑ DAIRY <br />® ABOVEGROUND TANK ❑ CHICKEN RANCH/ DOG KENNEL ❑ WASTEWATER TREATMENT PLANT <br />® HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEMICALTOILETS <br />❑ TIERED PERMITTED FACILITY ❑ POOLISPA I X] LAND USE APPLICATION SITES <br />❑ TATTOOIBODY 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 />1 ❑ Records provided by Staff -PPR Complete. Staff Name: ( ?t�o /F2V_' I <br />r �I / � 08/01/14 <br />Received Time May, 9, 2016 3:27PM No -0785 <br />0 <br />