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DATE RECEIVED FA <br /> i � � � " HD LOG NUMBER <br /> SAN JOAQUIN COUNTY iii <br /> ENVIRONMENTAL HEALTH DEPARTMENT r <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org <br /> U PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:lKristen Rini BUSINESS/AGENCY: IPM Environmental <br /> ADDRESS: 13400 Douglas Boulevard, Suite 200 CITY/STATE/ZIP: Roseville, CA95661 <br /> PHONE (1): (916)945-3778 PHONE(2):1(330)221-3440 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 REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Kristen Rini DATE 5/14/2014 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1. 1415 est Anderson Street Stockton <br /> 2. 820 ISouth Pershing Avenue ti�i , ❑p Unit 2 <br /> 3. 1443 Navy Drive ( � � <br /> 4. 1505 Navy Drive G '0 unit 3 <br /> S. �� INaVy Drive <br /> 6 b Unit 4 <br /> 7. <br /> 8 ❑Unit 5 <br /> 9. <br /> 10, ZGit 6 <br /> Specific Date Range of Information Requested: From 1900 <br /> to Pres/ ent <br /> ENVIRONMENTjkL HEALTH DEPARTMENT FILES <br /> [UNDERGROUND TANK(UST)CLEANUP SITE(LOP) t MEDICAL WASTE FACILITY OLID WASTE FACILITYNEHICLE <br /> 5/0THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ASTE TIRE <br /> [RUNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑ IRY <br /> &5BOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL STEWATERTREATMENT PLANT <br /> RDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL MPERTRUCKIYARDICHEMICALTOILETS <br /> IERED PERMITTED FACILITY ❑ OOUSPA NO USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING LVOMPLAINTIRESPONSE RECORDS THER(PLEASE SPECIFY) ny records of <br /> environmental <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-S:OOPM(EXCLUDING concern <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$125 deposit prior to review. 'BOXED AREA-EHD USE ONLY*** <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> 4128114 <br /> EHD 48-06 <br />