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1234 KLEINFELDER <br /> 13:14 06-29-2010 111 <br /> DATE RECEIVED � `1 <br /> IN COUNTY EH LOG NUMBE <br /> EALTH DEPARTMENT <br /> 60 <br /> as <br /> ckton, CA 95202.2708 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web: www.sigov.org/eh <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> '. <br /> 00lGAKT3 .liI 13USINESSIAGENCY: Q\ <br /> ADDRESS:_ ��g liIn� �C�'E� CITYISTATEIZIP O <br /> PHONE(1): T7- �1 J� PHONE(2): FACSIMILE: ✓ I <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow to business days fr date of a Ilcation submittal--Tentative only-must be confirmed) <br /> XICHECK BOX TO EXPEDITE REQUEST-fi S. D EE(CA 1 OR C CK ONLY)-REQUEST PROCESSED IN 3 DUSINE S DAYS <br /> SIGNATURE OF APPLICANT DATE �q0 <br /> Electronic Information: ❑List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street a Street Nam Cky — <br /> 1. nit 1 <br /> �esr Unit <br /> 3. (O C <br /> 4- SOU U�9 / a a <br /> S. ri> •� <br /> 6. Qqo Unit4 <br /> T. p t t%e <br /> LI90*. <br /> UnitS <br /> Unn5 <br /> ;q AM 1'r. - - N <br /> Specific Date Range of Information Requested: From 1C to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILMES <br /> .0-UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT 01OLID WASTE FACIUTYNEHICLE <br /> WOTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY 73 WASTE TIRE <br /> DERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL O <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 3WAS EWATERTREATMENT PLANT y A✓ 'r-/1/�O <br /> 0 TIERED PERMITTED FACILITY 0 MOTELMOTEL ❑PUMPER TRUCKIYARDICHEM TOILETS Y <br /> 0 TATTOOIBODY PIERCING 0 POOLISPA ,grND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACIUTY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW -MONDAY-FRIDAY 8:00 AM-5:OOPM - EXCLUDING HOLIDAY& <br /> 1. List up 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 1209)454-0138 or mail to the address Indicated above Address <br /> ranges will not be accepted-for additional asslsta�"Vle#dp see contact the END.Applications received after <br /> 3:00 pm will be processed the next business day. - Ate` ,R <br /> 2. The EHD will notify the applicant If any EHD files exist An appointment foe ir;r w will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five fidslness 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 appllraUOn 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$105.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If you need further assistance hose contact Dlone Martinez @ (209)468-3425 directly. Thank You yi5 <br /> - QIn t �I? <br /> - <br /> -to: LO <br /> P Lo11 <br /> j io: PrOd, �1�I�/1t a ��afCD 3)$ \,u-Ff l and cGt ON77 9uU51aXk�n) . I <br />