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raa iZs ;.LJ��x i - h Y �, y P f arnd�X 'ref} 3 ; u <br /> !pi t .� <br /> . �a�krix3ix '�,^ ;' <br /> � Kv t <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: a Z BUSINESS/AGENCY: <br /> ADDRESS: P C) Q� 'A S q � o, <br /> PHONE(1): (X0*?3A-0')0b PHONE(2): �-O r� FACSIMILE _ fl <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-''Tentative only-must be confirmed) <br /> L� CHECK SOX TO EXPEDITE REQ T-$95.00 FEE ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description:- <br /> FILE <br /> escription:FILE ADDRESS EHD USE ONLY <br /> Street# Street Name CityUnit 1 <br /> 1. { <br /> 001, <br /> 2. <br /> 4. Unit 3°_,(` <br /> 5. xUnit 4 <br /> 6. <br /> 7. <br /> Unit 5 <br /> 8. <br /> 9. <br /> unit s <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT 1011OLID WASTE FACILITYNEHICLE. <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR CHICKEN RANCH I,WASTEWATER TREATMENT PLANT <br /> ETEDICAL <br /> ERED PERMITTED FACILITY MOTEL/HOTEL PUMPER TRUCKIYARDICHEM TOILETS <br /> ATTOOIBODY PIERCING POOUSPA LAND USE APPLICATION SITES <br /> WASTE FACILITY OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDWG 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 appropriate <br /> box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD.Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The END will notify the applicant if any EHD files exist. An appointment 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 same applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-65 5116/2007 <br />