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01/24/2005 15:34 CLRYT OUP 4 12094640138 0 NO.839 D0 <br /><-.• aA. A.. y6"Qlzu ENVIRONMENTAL HEALTH PAGE 01 <br />DATE RECEIVED Cnu L.w V4VM0e,� <br />�- ,� ao�►QCO <br />Cor�T�r <br />EDDa DD Nv»ONM NTAL E T EPARTMENT Oaft <br />304 East Weber Avenue, 3'd F(oor, StOcktOn, C�-95202=2708 ---- - --- — ---- <br />coo <br />t 2�n05 Telepho-ne: (209) 468-3420 Fax: (209)464-0138 Web: WWW., <br />jgov.org/ehd <br />EN NicNT HEALTH PUBLIC RECORDS RIELEASE APPLICATION <br />P� SusiNESS1AGENCY: <br />Ao0REs5• .2a� � <br />a <br />PHONE ti): y - �6 �- PHONe t2): ZZs -4 - 3� ®Y FAcs)Mi� <br />TENTATIVE' APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of apolleaiian submittal-'r®rrtative only - must be confirmed) <br />Al- 4 c ECK BOX TO EXPEDITE REQUEST • $9a.00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED iN 3 BUSINESS DAYS <br />SiGNATUIR•F OF APPLICANT DATE <br />UNIT DISTRiaUTION Q unit i Unit 2 Unit 3 Unit 4 0 Unit 5 D unit 6 0 Other (eiectr0n(Cllistslmepa) <br />J <br />FILE ADDRFS1 END USE ONLY <br />V street p Street Name _ Gi — <br />IW ,�S 1. 3202 i -t M4r S _._. <br />•� , � S 0 W.ta�h mnw.- Cana — C) <br />s9�re'" <br />F—rio <br />--I— <br />FL-4 <br />END 4042-M <br />91:2:109 <br />10, i <br />Specific Date Range of information Requested: 'From tOP '— <br />FILES <br />(ell <br />ENVIRONMENTAL HEALTH Ol`PARTMENT <br />"NOE110AWND TANK (UST) CLAANUP SITE (LOP) D Houstwo AeATEmEQ SOLID WASTE PACILITYNF,wGi.E <br />NT 0 SOUR T1R£ <br />W <br />"THER CLEANuA SITF (NON -LOP) 0 Foot) F O <br />DAIRY <br />i�" iYNDERdROUND TANK (M°NITORIN0fREl4QVA0 0 000 KE t <br />R r'AST IkWATM TKPAT(0FNY PLANT <br />Z"AZARDOU9 WASTE GENERATOR ❑ CHICKEN RANCH <br />0 Moye MmTEL a PUMPER TRUCKNAADICNCM YDIL�TS <br />I) FAG 0 POOL/SPA ❑ LAND USE APPiI"TION SITES <br />� ±1fRE0 PERMIrTeD FACILITY <br />U <br />TATTOQfEODY P - <br />0 MECICAL WASTE FACILiYY Q OTHER (PLEASE SPee+Fl) <br />WELL AM SEPTI PERMIT FWCORO$ ARE AVAiLARLE FOR REvty • MONDAY-FRiDAY ®:00 NG HouDAYs. <br />the <br />above. <br />8Faz goes from <br />1. List up to ten addresses in the space <br />l type(s) <br />b� the <br />8 A6��135 or mot above tto theaddressess <br />UST <br />appropriate box(es). At least one file type <br />not be accepted — for additional assistance tntith file addresses, contact <br />indicated above. address ranges will <br />the END. Applications received after 3:00 pm will be processed the next bustn"s day, <br />An appointment for review will be confirmed <br />2. The END will notify the applicant if any END files exist. <br />days after receipt of applica . The files Will be held for a maximum of five business <br />approximately ten (10) <br />days for review. Appointments should be SCheduled accordingly. <br />immediately available for review. A new <br />3. A file that is actively being worked on by END sniff may not be <br />application may be submitted when the file is available. <br />will ae rAorganized by END staff at the expense of the <br />4. Any file not returned in the same condition as released <br />applicant- Future file reviews by the came applicant Wray require a $93.00 deposit prior to review. <br />END 4042-M <br />91:2:109 <br />