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304 East V&er Avenue,3`1 ton, CA 952 -2708 <br /> Telephone; (2 68-3420 Fax (209)464-013 Web:www v.or /ehd <br /> MAR t 2005 p <br /> EHVIROt4MEHT HEALTH LIC +CORDS RELFUSY,APPLICATION <br /> APPLICANT: BUSINESSIAGE,NCY: <br /> 01 <br /> ADDRESS: I n tsr� C <br /> PHONE(aj_ rime:PHONE(1); .-, <br /> TENTATIVE*APPOINTMENT DATE: t`f' �c ty-musk be confirmed) <br /> (Please allow 10 business days from date of application submittal-"Terlfative only-m <br /> ❑ CHECK BOX To EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)—REQUEST pROCESSED'IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT - '"'��,/' .., DATE <br /> ❑ Unit 1 ❑ Unit 2 Q Unit 3 nit 4 d Unit 5 <br /> C3 Unit 6 13 other(electronictliststmaps) <br /> UNIT D15TRtBUT10N <br /> FILE/4DDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 2. <br /> 3. 1. <br /> 4. <br /> G. use_— �� <br /> 7. - vA s-j- <br /> 67- <br /> t0 <br /> Specific Date Range of information Requested;From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> d HOUSING ABATEMENT Q SOLtP WASTE FAcILITYNEHICLE <br /> C3 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ®F000 FACILITY ®WAsTE TIRE <br /> ❑OTHER CLEANUP SITE(NON-LOP) O DOG KENNEL ❑DAIRY <br /> UNDERGROUND TANK(MONRORINGIREMOVAL) o CHICKEN RANCH ®WASTEWATER TREATMENT PLANT <br /> D HAZARDOUS WASTE GENERATOR D MoTELIHOTE:L ®PUMPER TRUCKIYARDICHEM TOILETS <br /> •TIERED PERMITTED FACILITY SPA ®LAND U56 APPLICATION SITES <br /> Q TATTOOIBODY PIERCING ❑0 POpUPOOUOTHER(PLEA$k SPECIxY) <br /> D MEotcAL WASTE FACILITY -'�C <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILAVLE FOR REVIEW- 1WONDAY FitIDAY 0:00 AM-S;QOPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space 'VA <br /> above. Select the ty�e(s)of fifes from the list abav®by checking the <br /> ess <br /> appropriate above. <br /> ). Aeleast <br /> ss ran es wilfilO l n t be a ceptede MUST be -foradditional assi t ce w th file addressesill to the. Fax to 209 1464-0138 or marcontact <br /> Indicated above. Addr ! 1 <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 <br /> tm be held fora will be confirmed <br /> m of <br /> business <br /> approximately ten (10)days after receipt Of application. Th fl <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively be' . -°corked on by EHD staff may not be immediately available for review. A new <br /> application may be su►; �i o ""n,4he file Is available, <br /> ' t-r� Ul /r�: as released will be reorganized by EHD staff at the expense of the <br /> 4. Any file not returned <br /> applicant. Future file C9 g;Z nt may require a$93.00 deposit prior fa review. <br /> EHb 48-02.006 <br /> 11=104RUSH <br />