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1U' � LL) SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> APR i 4 2017 &NVIRONMENTAL HEALTH DEPARTMEOP 85980 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRON 4EN TA,L HEffLIRphone: (209)468-3420 Fax: (209)464-0138 Web:www.sicehd.com Email: info@sicehd.com <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Donald B Mooney BUSINESS/AGENCY: Law Office of Donald B Mooney <br /> ADDRESS: 129 C St,Ste 2 CITY/STATE/ZIP: Davis, CA 95616 <br /> PHONE(1): . 530-758-2377 PHONE(2): FAX OR E-MAIL: <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 /> ❑ CHECK BOX TO EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Processed via mail by Staff. Dom M DATE April 24, 2017 <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 list <br /> 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 above, or email to info(a)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 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 will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$139 deposit prior to review. Z <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 <br /> HEALTH DEPARTMENT (Specific addresses only,address ranges will not be accepted) EHD USE ONLYFILES <br /> ®UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) ❑CONSUMER <br /> ®OTHER CLEANUP SITE(NON-69ZO Frewert Rd Lathrop <br /> E HAZARDOUS WASTE', ' DAIRY <br /> ®TIERED PERMITTED FACILITY 2 <br /> ®ABOVEGROUND TANK <br /> ®UST (MONITORING/REMOVAL) PWS <br /> ®HAZARDOUS MATERIALS 9 <br /> ®SPILURELEASE RESPONSE <br /> ®WATER QUALITY <br /> E SOLID WASTE FACILITY/VEHICLE 4 <br /> ❑FOOD FACILITY <br /> ❑ <br /> POOL/SPA ®SITE MITIGATION <br /> ❑DAIRY 5 <br /> ®LAND USE APPLICATION SITES <br /> HOUSING <br /> SEPTIC PUMPER TRUCK/ <br /> 6 <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT ®CUPA <br /> HOUSING ABATEMENT 7 <br /> MOTELIHOTEL <br /> CHICKEN RANCH/DOG KENNEL ®CUPA-UST <br /> MEDICAL WASTE FACILITY J"7 <br /> TATTOO/BODY PIERCING 1 `reg' / 1n ®SOLID WASTE <br /> 9 <br /> WASTE TIRE q �i I f4 I v� <br /> ®COMPLAINT <br /> OTHER(PLEASE SPECIFY): ACCOUNTING <br /> 10 <br /> —BOXED AREA-EHD USE ONLY— <br /> s ` C40 s _ <br /> - - )n;1a4 44 Aa <br /> n <br /> - kh� rQ <br /> 0 Records provided by Staff-PPR Complete. Staff Name: f <br />