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SANcOAQUIN RECEIVE vironmental Health Department <br /> I, r■� �' `i COUNTY PAY <br /> ry1 /(n�P�UJBLIC RECORDS RELEASE APPLICATION <br /> 61 <br /> r A1 9 6 2018 1 / <br /> ;.;reatness grows her: + � �,- ., A�'1 88795 <br /> --NVIRONMENTRLH EHD LOG NUMBER: <br /> APPLICANT: DAVID BOLE PEMUSERVICES BUSINESS/AGENCY: BOLE&ASSOCIATES <br /> ADDRESS: 6898 PENNY WAY CITY/STATE/ZIP: BROWNS VALLEY, CA 95918 <br /> PHONE (1): 530-415-6623 PHONE (2): 530-743-7093 FAX OR E-MAIL: DAVIDBOLE@YAHOO.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 info(Dsicehd.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. 7 <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 FILE ADDRESS A-" <br /> HEALTH DEPARTMENT ( p Y 9 accepted) EHD USE ONLY <br /> FILES (Specific addresses only, address ranges will not be acce ted <br /> Underground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) } ��v-�LTi (� �• []CONSUMER <br /> t 2303 WEST LN STOCKTON <br /> Other Cleanup Site(Non-LOP) <br /> ® Hazardous Waste DAIRY <br /> ®Tiered Permitted Facility 2 HM, HW,AST,CO <br /> ®Aboveground Tank <br /> ❑PWS <br /> E] UST (Monitoring/Removal) <br /> 3 <br /> ® Hazardous Materials <br /> ®Spill/Release Response WATER QUALITY <br /> Solid Waste Facility/Vehicle 4 <br /> ❑Food Facility <br /> Pool/Spa SITE MITIGATION <br /> Dairy 5 <br /> F1 Land Use Application Sites ❑HOUSING <br /> Septic Pumper Truck/ 6 <br /> Yard/Chemical Toilets <br /> ❑Wastewater Treatment Plant ®CUPA <br /> Housing Abatement 7 AST/HM/HW <br /> Motel/Hotel CUPA <br /> Chicken Ranch/Dog Kennel <br /> $ UST <br /> Medical Waste Facility <br /> Tattoo/Body Piercing SOLID WASTE <br /> ❑Waste Tire 9 <br /> ® Complaint <br /> F1 Other(Please Specify): ACCOUNTING <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 (Q 22 lie-- int-#S 5 M <br /> in Aft bw GU-5 �fix 2$03 West In <br /> Y <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: EHD 48-0e <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />