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11• wu. c.vio 'i : Ov : .30 r11 -UODU PAAUUM AAYWHERE PAGE 3 OF 3 <br /> DA IE r W EHD LOG NUMBER <br /> SAN .1OAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> NOV ( ?'fiy 1868 East Hazelton Avenue, Stockton, CA 95205-6232 e�501 (p <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: vAm,sjgov.orglehd <br /> 1"R0� L HEALTH <br /> ` PERM1TMEWMCIES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Amanda Benbow BUSINESSIAGENCY: PM Environmental <br /> ADDRESS: 3400 Douglas Blvd Suite 200 CITYISTATE/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 arran a an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE UEST 30 FEE(CASE{OR CHECK ONLY)-REQUE=ST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 1118!2016 <br /> Electronic Information: ❑ List ❑ Map - Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City �i jt'S -U 5 i (O <br /> U 1 <br /> 1. 1789 West Charter Way 7-Stockton GJ j_ aIL 2, 1817 South Fresno Ave ,894 r <br /> No unit 2 <br /> 3. <br /> 4. <br /> 15�unit 3 <br /> y� 5. <br /> 6. <br /> 7 <br /> S. <br /> 9. ❑Unit 5 <br /> 10. <br /> [a/uffi <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FAGIL[TY ❑SOLED WASTE FACILITY IVEHICL E <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ®UNDERGROUND TANK (MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ®ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KFNNEL <br /> ® ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS <br /> ❑TIERED PERMITTED FACILITY ❑MOTELfHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TAT1001BODY PIERCING ❑COMPLAINTIRFSPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-r RIDAY 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 fist 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 wlil 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 /> jo <br /> r <br /> II 7C %n i <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> Received Time Nov, 8, 2016 1 : 27PM No, 0315 06101118 <br />