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05/09/2016 6 28:41 PM –0400 FAXCOM ANYWHERE PAGE 2 OF 2 <br />D )v i VE t SAN ciOAQUIN COUNTY EHD LOG NUMBER � <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />MAr 19 2€16 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />" Nv)N�MENTALHFTe[ephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />G ,1RONI7FS <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Amanda Benbowbenbow@pmenv.com BUSINESS/AGENCY: PM Environmental Inc. <br />ADDRESS: 3400 Douglas Blvd Suite 200 CITY/STATE/ZIP: Roseville, CA 95661 <br />PHONE (1): (916) 472-2870 PHONE (2): <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 EXPEDITEE UEST S 0 FEE (CASH OR CHECKONLY)- 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 />Un 1 <br />Street# Street Name city <br />1• <br />1115 <br />West Yosemite Ave <br />Manteca <br />j}�jT 1 J - r <br /><j Z <br />•5 <br />Unit <br />2. 1145 West Yosemite Ave Manteca <br />3` <br />�1048 <br />West Yosemite Ave <br />Manteca <br />NO C.+•ijq+ UA 1 t6015r <br />VO A) a W /10 <br />19/Unit 3 <br />4. 1060 West Yosemite Ave Manteca <br />5� <br />1257 <br />West Yosemite Ave <br />Manteca <br />-,✓rJ('015 <br />NQ l P <br />� n14 <br />6. 1160 West Center Street Manteca <br />7. <br />❑ Unit 5 <br />8. <br />9. <br />gum -Ir <br />10. <br />M <br />+;j(#,r,7t' <br />Specific Date Range of Information Requested: From earliest available to present <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />® UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ MEDICAL WASTE FACILITY ❑ SOLID WASTE FACILITY •I/V_EHICL n_ <br />® OTHER CLEANUP SITE (NON -LOP) E] HOUSING ABATEMENT [:]WASTE TIFT, `� fj ( _ 9/ <br />RX UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ FOOD FACILITY DAIRY �7 } `t,�1 j— � w f ^ <br />® ABOVEGROUND TANK- [:1 CHICKEN RANCHI DOG KENNEL ❑ WASTEWATER TREATMENR PLANT I, I �l'"I `r' <br />® HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />❑ TIERED PERMITTED FACILITY ❑ POOLISPA © 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 after3:00 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 />ANA d <br />11 4 i/.(f1i �% I)♦.l • jijl�j�\]lil .I // - L 11 P I. <br />u1Ra <br />rl'�"Trs fy <br />