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12/29/2}0116 2 : 56 : 33 PM —0500 FAXCOM ANYWHERE PAGE 3 OF 3 <br /> DATE:%Ci+1Vtb' SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> DEC 2 9 201691520V`0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • bWAje "te: (20:9) 468-3420 Fax: (209) 464-0138 Web: wvvw.sjgov.org/ehd <br /> PEIvneRISUIERVtCES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Amanda Benbow BUSINESS/AGENCY: PM Environmental <br /> ADDRESS: 3400 Douglas Blvd Suite 200 CITY/STATE/ZIP:Roseville,CA 95661 <br /> PHONE (1): 916-472-2870 PHONE (2): FACSIMILE: 877-884-6775 <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 EXPEDIT CUES 30 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN DATE December 29,2016 <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1. 1102 School Avenue Stockton uFs' <br /> 2. 1100 North Wilson Way Stockton WPP, —CD d Unit2 I(� <br /> 3. 1152 School Avenue Stockton My !1 <br /> 4. Pn),i4o�,L0• dUnit 3 <br /> 6. —t—I llO si <br /> 7. <br /> n. <br /> ❑ Unit <br /> 9. <br /> �10. Ik 6 9"0I i�Ir <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACIUTYNEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINWREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ®ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ©HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYAROICHEMICALTOILETS <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 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 /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> Received Time Dec. 29. 2016 11 : 23AM No. 0570 08)0111' <br />