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RECEIVED <br />SAN JOAQUi N �;f t� i ,J Environmental Health Department <br />COUNTY PUBLIC RECORDS RELEASE APPLICATION <br />FJVVIR WITI E r� r„ <br />PEI�'1AIT/St= iy�T BY EMAIL i`,(J,�I <br />_ EHD LOG NUMBER: <br />APPLICANT: ARP MINI Miami a"/ gOF544D PXT1 B90SINESS/AGENCY:61219 M) <br />ADDRESS: 2-5-77-5- S. -r-Ir /L D ill$t CITY/STATE/ZIP: ;Q <br />PHONE (1): C0) " �- S-Lf-� PHONE (2): FAX OR E-MAIL: ,144 f (# wi-Y-C. Cn� <br />Please allow 10 business days from date of application submittal for the records to be available. <br />Staff will contaVes9`jMc4 <br />u to arrangean appointment date and time to review the requested re ords. <br />SIGNATURE OF APPLICANT DATE 20 <br />1. List up to ten addresses int below. Address ranges WILL NOT be accepted. Select the ty e(s) o 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@sicehd.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 />HEALTH DEPARTMENT <br />FILES <br />(Specific addresses <br />(p <br />FILE ADDRESS <br />only, address ranges will not <br />y 9 <br />accepted) <br />be acce ted <br />EHD USE ONLY <br />❑ Underground Tank (UST) <br />Street # <br />Street Name <br />City <br />1 1 <br />7 1 I <br />rr n O Iv <br />S P! t I I. I\S 1 <br />T�14( y <br />❑ CONSUMER <br />Cleanup Site (LOP)1 <br />Other Cleanup Site (Non -LOP) <br />Hazardous Waste <br />❑ DAIRY <br />❑ Tiered Permitted Facility <br />2 <br />Aboveground Tank <br />❑ PWS <br />® UST (Monitoring /Removal) <br />Hazardous Materials <br />3 <br />Spill / Release Response <br />Solid Waste Facility / Vehicle <br />❑ Food Facility <br />4 <br />n <br />❑ WATER QUALITY <br />5 <br />U, <br />ll// <br />❑ SITE MITIGATION <br />Pool / Spa <br />❑ Dairy <br />❑ Land Use Application Sites <br />Septic Pumper Truck / <br />6 <br />❑ HouslNc <br />Yard / Chemical Toilets <br />Wastewater Treatment Plant <br />❑ CUPA <br />Housing Abatement <br />7 <br />AST / HM / HW <br />❑ Motel/Hotel <br />8 <br />❑ CUPA <br />UST <br />❑ Chicken Ranch / Dog Kennel <br />Medical Waste Facility <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 />ofo V b- V <br />Records provided by Staff -PPR Complete. Staff Name: Y ► L EHD 48-06 <br />