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4 <br />=r SANSIOAQUIN <br />COUNTY <br />�.'reatness grows here <br />APPLICANT: DAVID BOLE <br />ADDRESS: 6898 PENNY WAY <br />RECEIVEovironmental Health Department <br />PUBLIC RECORDS RELEASE APPLICATION <br />MAY 16 2016 k,)I <br />ENVIRONMENT' HEALTH EHD LOG NUMBER:8879,r-, <br />BUSINESS/AGENCY: BOLE & ASSOCIATES <br />CITY/STATE/ZIP: BROWNS VALLEY, CA 95918 <br />PHONE (1): 530-415-6623 PHONE (2): 530-743-7093 FAX OR E-MAIL: DAVIDBOLEPYAHOO.COM <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 />SIGNATURE OF APPLICANT PROCESSED VIA EMAIL BY STAFF. DOM M DATE MAY 16, 2018 <br />1. List up to ten addresses in the space below. Address ranges WILL NOT be accepted. Select the type(s) of 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 infoPsicehd.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: <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL <br />FILE ADDRESS <br />A 1,2.74+ <br />HEALTH DEPARTMENT <br />FILES <br />(Specific addresses <br />only,address ranges will not <br />be accepted) <br />EHD USE ONLY <br />Underground Tank (UST) <br />Street # <br />Street Name <br />City <br />Cleanup Site (LOP) <br />'�'�, AST, CID ❑ CONSUMER <br />F1 Other Cleanup Site (Non -LOP) <br />� <br />2303 <br />WEST LN <br />STOCKTON <br />® Hazardous Waste <br />❑ DAIRY <br />® Tiered Permitted Facility <br />2 <br />HM, HW, AST, CO <br />® Aboveground Tank <br />❑ PWS <br />E] UST (Monitoring / Removal) <br />® Hazardous Materials <br />s <br />® Spill / Release Response <br />❑ WATER QUALITY <br />Solid Waste Facility / Vehicle <br />4 <br />Food Facility <br />❑ SITE MITIGATION <br />Pool / Spa <br />F] Dairy <br />5 <br />Land Use Application Sites <br />[:)HOUSINGSeptic <br />Pumper Truck / <br />5 <br />Yard / Chemical Toilets <br />❑ Wastewater Treatment Plant <br />® CUPA <br />❑ Housing Abatement <br />7 <br />AST/ HM / HW <br />F1 Motel/Hotel <br />❑ CUPA <br />Chicken Ranch / Dog Kennel <br />Medical Waste Facility <br />8 <br />UST <br />Tattoo/Body Piercing <br />❑ SOLID WASTE <br />Waste Tire <br />g <br />® complaint <br />❑ ACCOUNTING <br />Other (Please Specify): <br />10 <br />.**BOXED AREA - EHD USE ONLY*"* <br />5/16/2018 - APPLICANT NEEDS PREVIOUSLY CANCELED REQUEST FOR CUPA HM FILES. GENERATED NEW PRRA AND <br />INFORMED THEM OF THE DELAY. DOM M (91 (` W32513L-I R Pj)mRnialo Otre.. <br />1 ❑ Records provided by Staff -PPR Complete. staff Name: - EHD 48-06 1 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />