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07- 81 09147RM FRC _ TC l jlb�i� iltibvl i . r ti <br />(209)468-3420 C� J <br />ZOO PUBLfC RECORDS RELEASE APPLICATION <br />l=�,�AFP41Cj�TlT' h!el\TEIt�� BUSINESSIAGEHCY C-T�Tt� S I N C. <br />L <br />i -rpt Yi i-�i <br />r> <br />PHONE <br />U <br />PHONE (°!lam) t -6-- L80:1 _ _ __ FACSIMILE 9t� S5 3 —t gtQa <br />r p <br />TENTATiVE'APPOINTMENTDATE .�UL-`f� 27� O� TIME P1"` CulJl <br />(Pleasc give 7 to 10 business Gays trom date of application submittal) <br />TS 3 w« t3fe,tit�, crict� <br />CHECK BOX`TO EXPEDITE REQUESz4e,,_41 <br />FREQUEST PROCESSE IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />0 <br />UNDERGROUND TANK (UST) CLEANUP SITe (LOP) <br />F1LE ADDRESS <br />0 SOLID WASTE FACILITY <br />THIS SW£ EHD STAFF USE ONLY <br />PRQGRAM Ei _MINTS SEARCH <br />7 25 Coo is TR -Y <br />L't-vB t34 -v R <br />roc �a <br />O DOG KENNEL <br />O DAIRY <br />U HAZARDOUS WASTE GENERATOR <br />O CHICKEN RANCH <br />O PKG TREATMENT PLANT <br />❑ TIERED PERMVT5D FACILITY <br />O MOTEUHOTEL <br />5 Cir-�rR-}i <br />C•-u� �-�t�. <br />St�cr- <br />� <br />. <br />2 I rte' 7V%, r4 A, <br />ZVRt u ST <br />-,or- 1C-TtAl <br />L <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />0 <br />UNDERGROUND TANK (UST) CLEANUP SITe (LOP) <br />❑ HOUSING ABATEMENT <br />0 SOLID WASTE FACILITY <br />o'rkEK CLEANUP 517E (NON -LOP) <br />13 FOOD FACILITY <br />O SOLID VYASTF VEHICLE <br />O UNDERGROUND TANK (M0NtTOR1NGtRE1%10VAL) <br />O DOG KENNEL <br />O DAIRY <br />U HAZARDOUS WASTE GENERATOR <br />O CHICKEN RANCH <br />O PKG TREATMENT PLANT <br />❑ TIERED PERMVT5D FACILITY <br />O MOTEUHOTEL <br />Cl PUMPER TRUCWTARDICHE41 TOILETS <br />Q TAT; OOIBOpY PEIRCING <br />L3 POOUSPA _. ` <br />E7 LAND USI: APPLICATICN SITES <br />C mEriCAL WASTE -FACILITY <br />Q PUBLIC WATER SYSTVM <br />t7 OTKeR (PL.8AS1' SPLCIFYAeOVL) <br />1. List up�b ten addresses in the space above. Select the type(s) of files from the list above by checking <br />the appropriate box(es). At least one file type MUST be selected. Flax to f2") 464=013$ or mail to the <br />address indicated above. <br />2. EHD will notify the applicant if any EHD files exist. An appointment for review will �e confirmed <br />approximately five business days but no later than ten (10) days after receipt of application. The files <br />will be held for a maximum of five business days for review. Appointments should ba scheduled <br />accordingly. <br />3. A file that is actively being worked on by EHO staff may not be immediately available for review. A new <br />application may be submitted when tho fiie.is available. <br />R. Any fisc not returned In the same condition as releasted will be raorganizad by EHD staff at the expense <br />of the applicant, Future file revlow5 by the sank applicant may requiro a $87.00 deposit prior to review. <br />5. 'TENTATIVE appointment dates must be confirmed with EHD staff, <br />6. Applications received after 3:00 pm will be processed the next buslness day. <br />COKFIRNED APPOINTMENT DATE <br />;DATE CONFIRMED <br />'REVIEWED YIES <br />My <br />TIME <br />PHONE FAX <br />REvIEW DATE <br />INrr(ALS . <br />a IUIHL. V.02 <br />