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CEIVED <br /> Environmental Health Department <br /> SAN MOAMAR o � �o, a <br /> --- C O U N T Y----- PUBLIC RECORDS RELEASE APPLICATION <br /> Greatness cy r o�ti s �F <br /> 1I/I�AI. EIL� <br /> rT/ BY EMAIL <br /> EHD LOG NUMBER: <br /> APPLICANT: C 1.�1` u� BUSINESS/AGENCY: <br /> ADDRESS: 1a 1Q C- NC1�Mw� _ Lc1t„< "jUC�iCwCITY/STATE/ZIP: i✓/}—Gj 5-,P\1 O <br /> PHONE(1): � y �a. ash PHONE(2):a%4 93i—sb 3i FAX OR E-MAIL: :6wc \eA .)4 Q a wk).0u-1 <br /> Please allow 10 bus" ess days from date of application submittal for the records to be available. d <br /> Staff will contact y to arran r�I,pointment date and time to review the requested+r�ecords. <br /> SIGNATURE OF APPLICANT DATE — C l 4 a Q ) <br /> 1. List up to ten addresses in th elow. A&Iress ranges WILL NOT be accepted. Select the typ�f files from the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138, mail to the <br /> address indicated below,or email to infoOsicehd.com. Applications received after 3:00 pm will be processed the next <br /> business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted below. <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$152 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List ❑ Map — Description: S�3 'TC�y\\_ ISI cue. v ,r f <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT 9 p <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) c, ❑CONSUMER <br /> Other Cleanup Site(Non LOP) 1 'o �_ 1. 'v l�\ La�� J ('"'/v (2 9 S a� <br /> Hazardous Waste ❑DAIRY <br /> Tiered Permitted Facility 2 <br /> Aboveground Tank <br /> UST (Monitoring/Removal) <br /> ❑PWS <br /> F] Hazardous Materials 3 <br /> Spill/Release Response <br /> WATER QUALITY <br /> Solid Waste Facility/Vehicle 4 ❑ <br /> Food Facility <br /> Pool/Spa ❑SITE MITIGATION <br /> Dairy 5 <br /> Land Use Application Sites <br /> f! R <br /> j HOUSING <br /> F-1 <br /> Septic Pumper Truck/ 6 ❑ <br /> Yard/Chemical Toilets <br /> Wastewater Treatment Plant ❑CUPA <br /> Housing Abatement 7 AST/HM/HW <br /> Motel/Hotel <br /> Chicken Ranch/Dog Kennel ❑CUPA <br /> Medical Waste Facility 8 UST <br /> Tattoo/Body Piercing ❑SOLID WASTE <br /> Waste Tire g <br /> Complaint <br /> Other(Please Specify): ❑ACCOUNTING <br /> 10 <br /> ***BOXED AREA-EHD USE ONLY*** <br /> Records provided by Staff-PPR Complete. Staff Name: Wce EHD 48-06 <br />