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IS <br />1234 <br />DATE RECEIVED <br />V1 CN« <br />ER 3.14 06-29-2010 1l1 <br />EH LOG NUMB <br />� , %( 11N COUNTY <br />j,L`N'It0NA1ENTAI74EALTH DEPARTMENT <br />600 East faint ckton, CA 95202-2708 31( <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/eh <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: :'.. , <br />PHONE (1): PHONE (2): FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days frojin date of anollcatlon submittal - 'Tentative only - must be confirmed) <br />; 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 ;ZoJO <br />Electronic Information: ❑ List ❑ Map — Description: <br />Specific Date Range of Information Requested: From e� Cir, to <br />�,/ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />.e UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT g SOLID WASTE FACILITYNEHICLE <br />Ja OTHER CLEANUP SITE (NON -LOP) CI FOOD FACILITY Q WASTE TIRE / <br />gGDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />EI HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH OVASTEWATER TREATMENT PLANT ✓ <br />O TIERED PERMITTED FACILITY 17 MOTEL/HOTEL ❑PUMPER TR K/Y /C T <br />UC ARD HEM OILETS <br />0 TATTOO/BODY PIERCING 0 POOL/SPA I2'GNO USE APPLICATION SITES <br />MEDICAL WASTE FACILITY O OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br />1. List un 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 (2091464-0138 or mail to the address Indicated above Address <br />ranges will not be accepted — for additional assists t le dr ses, contact the EHD. Applications received after <br />3:00 pm will be processed the next business day. ',� <br />e� Pp <br />2. The EHD will notify the applicant If any EHD flies exlst An appolntmen# for revkew will be confirmed approximately ten (10) <br />days after receipt of application. The files will be held fora 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 />'1-10 : Cj 1t° (VIA 40/V]ku v <br />CoM" 00 /1 _ d I) <br />Pcam. <br />a ��pi►32� <br />PFJ, A'f>V i �t a (-opo CD 3�5�- O�'Fifh <br />f a nd u;�oo8y�� quu soon) . vy�> <br />