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<br /> PUBLIC MECO l.: �„ tee i .
<br /> �// r f YI^, / ti IxASS:APPLICATION
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<br /> APPLICANT_ YL1 I L gGETfiC`Y:
<br /> ADDRESS: 61R�� Ot{ CEvI`fPn cva L4 c'
<br /> PHONE(1):_ (z S � �°�d-"y PHONE(Z):_ ��7T S���j C? � Z FACSIMI>_E: d `0�0�o
<br /> TENTATIVE*APPOINTMENT DATE: -�� � �S f ZaO 7 Time: 16),' 3L n�
<br /> (Please allow 10 business days from date of application submittal-`Tsntsfiva only-must be confirm®d)
<br /> M _�;K BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS
<br /> Ad SIGNATURE OF APPLICANT 1e, DATE / - f G7 El
<br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 ❑ UnIt 3 ❑ Unit 4 ❑ Unit 5 ❑ Unit B ❑ Other(electronlUlists/maps)
<br /> FILE ADDRESS EHD USE ONLY
<br /> Street ff Street Name City
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<br /> Specific Bete Range of Information Requested:From Up,�6�� to cc.s G,IIcV;�cb/r�
<br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES
<br /> 9 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE PACILITYIVEHICLE
<br /> P4 OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE
<br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY
<br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT 44
<br /> 9 TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEM TOILET$
<br /> ❑TATT001RODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES
<br /> ❑MEDICAL WAST? FACILITY U OTHER(PLEASE SPECIFY) 0
<br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONOAY-FRIDAY$:00 AM-6:OOPM - EXcwniNG HOLIDAYS.
<br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking the
<br /> appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the address N"
<br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact
<br /> the EHD.Applications received after 3:00 pm will be processed the next business day.
<br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for %%D
<br /> review will be confirmed
<br /> 4:... approximately ten (10)days after receipt of application. The files will be held for a maximum of five business
<br /> days for review. Appointments 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
<br /> application may be 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
<br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review.
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