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0 <br />1234 <br />DATE RECEIVED <br />=n '3:14 06-29-2010 111 <br />EH LOG NUMBE <br />aS 1 IN COUNTY <br />N'WONMEN�'AL�� EALTH DEPARTMENT <br />600 East 1Vfn Vit. ckton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/eh <br />PUBLIC RECORDS RELEASE APPLICATION <br />i4RPUCNT: <br />PHONE (1): 05'77' 43i!.'� PHONE (2): <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days fr date of a lication submittal -*Tentative only -must be confirmed) <br />JCHECK 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 x010 <br />1 <br />SIVAt <br />�I ■ <br />' .a�w9 • ' • Y� <br />+� <br />r �1i1, <br />Specific Date Range of Information Requested: From �%YC to 7��]_t•„_nA_ <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />.0 UNDERGROUNO TANK (UST) CLEANUP SITE (LOP) E3 HOUSING ABATEMENT b SOLID WASTE FACILITYNEHICLE 1{ <br />MOTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY C3 WASTE TIRE ' 1 ►� <br />gGDERGROUNDTANK (MONITORINGIREMOVAL) 11 DOG KENNEL 13 DAIRY Wjl �(/I/�� <br />HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH OV/ASTEWATER TREATMENT PLANT v /� I//✓'7 " <br />❑ TIERED PERMITTED FACILITY MOTELIHOTEL ❑PUMPER TR KIY /C Y <br />❑ <br />TATTOO/BODY PIERCING UC ARD NEM TOILETS <br />POOLISPA 0-•GND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY O OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RENEW - 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 assista?"14 le id�g ses contact the EHD. Applications received after <br />3:00 pm will be processed the next business day. d <br />2. The EHD will notify the applicant If any EHD files exist IAnappolntment 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 />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 some applicant may require a $105.00 deposit prior to review. <br />***If you need further assistance <br />7IlD q1 <br />ENO fB-06 <br />�-i-lo: Prop•, ��� �e/)1- Q <br />EHD USE ONLY <br />contact Diane Martinez @ <br />of co <br />\-�)• FNS <br />3425 direct) . Thank You*** 5 i5 <br />d LD$pi132� <br />,nd c�o8y�� qyu s�OcXl�n) I� <br />