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0 <br />1234 KLEINFELDER 3 14 06 29 2010 <br />DATE RECEIVED <br />APPLICANTi r'.'• `; I <br />1 <br />ADDRESS: ,)/ t <br />EH LOG NUMB <br />E <br />SA W IN COUNTY <br />a N 'L�tONMENT4ockton, <br />EALTH DEPARTMENT <br />600�East Mei CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/eh <br />I PUBLIC RECORDS RELEASE APPLICATION <br />PHONE (1): " 43J435'X) PHONE (2): <br />ENCY: <br />CITY/STATE/ZIP 1 to1fsRi t 1 <br />�^ FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days fr date of a Iication submittal -*Tentative only -must be confirmed) <br />Rr"CHECK BOX TO EXPEDITE REQUEST. =1 5. 0 EE (C OR C CK ONLY) -REQUEST PROCESSED IN 3 BUSINE S DAYS <br />SIGNATURE OF APPLICANT DATE ao10 <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS _ EHD USE ONLY <br />Street k <br />Street Name <br />� - <br />� <br />Ae <br />City T✓1 a nit 1 <br />--- <br />tom- - ����1j F � � <br />F1Vv ©��J �� Unit 2 <br />wit s <br />60 i Unit 4 <br />�- Unit 5 <br />u�- <br />Unit 6 <br />N <br />1. <br />- <br />A -OTHER CLEANUP SITE (NON -LOP) <br />plhJDERGROUND TANK (MONITORINGIREMOVAL) <br />2. <br />Q WASTE TIRE <br />13 DAIRY <br />3. <br />4. <br />EI HAZARDOUS WASTE GENERATOR <br />O CHICKEN RANCH <br />5. <br />U <br />`1C <br />li. <br />a O <br />8. <br />9- <br />O MEDICAL WASTE FACILITY <br />O OTHER (PLEASE SPECIFY) <br />10. <br />,� 5$ <br />Specific Date Range of Information Requested: From - -?Mc. to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />�,� <br />Ja UNDERGROUNO TANK (UST) CLEANUP SITE (LOP) <br />13 HOUSING ABATEMENT <br />n SOLID WASTE FACILITYNEHICLE <br />"1 <br />A -OTHER CLEANUP SITE (NON -LOP) <br />plhJDERGROUND TANK (MONITORINGIREMOVAL) <br />❑ FOOD FACILITY <br />11 DOG KENNEL <br />Q WASTE TIRE <br />13 DAIRY <br />I 1 (�y <br />Wjl <br />EI HAZARDOUS WASTE GENERATOR <br />O CHICKEN RANCH <br />BVASTEWATER TREATMENT PLANT <br />O TIERED PERMTTED FACILITY <br />TATTOOBODY PIERCING <br />❑ MOTELIHOTEL <br />0 POOL/SPA <br />❑ PUMPER TRUCKIYARD/CHEM TOILETS171 <br />01".AND USE APPLICATION SITES <br />y�A/✓�j <br />Y <br />O MEDICAL WASTE FACILITY <br />O OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM.5:00PM - FYr-I Ilnmr. Hni 1hAVQ <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address Indicated above. Address <br />ranges will not be accepted — for additional assistapitt�ileldrsses, contact the EHD. Applications received after <br />3:00 pm will be processed the next business day. , �. x'? <br />2. The EHD will notify the applicant if any EHD flies exist wAn appointment for rev(i3w 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 />3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A new application may be <br />submitted when the file Is available. <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 $105.00 deposit prior to review. <br />END USE ONLY <br />***If you need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You*** <br />- -Ip : coat c� >70(0(� <br />1 r <br />EMD 48-06 � - - - <br />x+10: P,00", a:.rpll 04'7 0 (4Py0t coy - 1>l9' ht�tU oBy�� �uus�ocxi�n) � <br />