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__ _. - .. . .r-„ LU`J bb f-ybbb p.1 <br /> DATE RECEIVED <br /> � • EHO LOG NUMBER <br /> RE E(1 V EDD ENVIRONMENTAL HEALT DEPARTME <br /> 304 East Weber Avenue, 3d Floor, St ckton, CA 952012-23Zad- 505 <br /> I1tL 2 Q 20()7 Telephone:(209)468-3420 Fax: (209)464-Q138 Web: www.sl <br /> ENVIROWENT HEALTH PURBLIC RECORDS RELEA E APPLICATIONAA _ <br /> PER APPLICANT: t i N !F\ �'� BUSINESSIAGENCY: R4•e <br /> ADDRESS: 3`'Hi o N-Golds., S4e1{e- Alt,tl . * C, , `prlock 9S3& n; <br /> PHONE(1):3-39 Co C-7- G&7't PHONE(2): Z5ZP (076 Z SZ FACSIMILE: Co('-4- 9(o(oy <br /> TENTATIVE"APPOINTMENT DATE: 1 O Time: 10.3c, <br /> (Please allow 10 business days from date o application sub ntbil-`Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$95.00 FEE(CASH OR CHEC ONLY)-REQUEST PROCESSED IN 3 USINESS DAYS <br /> SIGNATURE OF APPLICANT vinnr`JJlTI_VI,,\ DATE fZ Z1-4 cl_} <br /> Electronic Information: ❑ List❑ Map—Description: - <br /> FILE ADDRESS EHD USE ONLY <br /> street a Street Name Ci ❑ Unit 1 <br /> 6 :71. Z356� <br /> 2. ❑ Unit 2 <br /> 3 <br /> O 4. Unit a <br /> \\ 6 Unit4 n <br /> 7. \"Lh <br /> \ 8 ❑ unit 5 <br /> 9. <br /> 10 ElUnit 6 <br /> Specific Date Range of InfomTation Requested:From to CQ ofbA <br /> .,,,J ENVIRONMENTAL HEALTH DE ARTMENT FILES &52 <br /> )S UNDERGROUND TANK(UST)CLEANUP SITE(LOP) CI HOUSING ABATEMENT 12 SOLID WASTE FACIDTYiVENICLE f <br /> 0 OTHER CLEANUP SITE(NON-LOP] O FDOD FACILITY 13 WASTE TIRE <br /> .)$UNDERGROUND TANK(MONITORWG/REMOVAL)✓ ❑ DOG KENNEL ❑DAIRY F M/ <br /> O HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH 11 WASTEWATER TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY ❑MOTEIJHOTEL ❑PUMPER TRUCK/YARDICHEM TOILETS <br /> 0 TATTOOIBODY PIERCING ❑POOL/S PA ❑LAND USE APPLICATION SITES - <br /> 17M1EDICALWASIEFACILITY ❑OTHER(PLEASE SPECI)Y.FFUDAY <br /> ) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MOH 8:00 AM-6;0orm - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of fi s from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 209 464- 138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file add esses,contact the EHD.Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant If any EHD files exist. An appointr ent for review will be confirmed approximately ten (10) <br /> days after receipt of application. The files will be held for a maxima n 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 imm diately 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 raorg nized by EHD staff at the expense of the applicant <br /> Future file reviews by the same applicant may require a$95.00 depc At prior to review.. <br /> EHD USE ONLY <br /> EHO48.06 9NW006 <br />