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ENVIRONMENTAL <br /> 304 East Vj er Avenue,3'� ton,CA 95202-'708 <br /> MAR 7005 Telephone: (201W$-3420 Fax (209)464-013 Web:www_ org/ehd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: SUSINESSIAGENCY: r`Y� <br /> ADDRESS:rv�� ; F <br /> PHONE(7):c�1Pi _„_ PHONE(2): -��l7 � FACSIMIL <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-"TeaTtafiv9 only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)—REQUEST PROCESSED-IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT //I., /Llr^.,Ed�, ° DATE <br /> UNIT DISTRIBUTION E3 Unit 1 0 Unit 2 ❑Unit 3 nit 4 0 Unit 5 ® Unit 6 0 Mar(electronionistslmaps) <br /> FILL ADDRESS END USE ONLY <br /> Street# Street Name city <br /> 2. 7 <br /> 3. <br /> 4. - <br /> s. <br /> 6. LAS <br /> 7 fes' <br /> 8. <br /> 10. Al67- 1 <br /> u.I <br /> Specific Data Range of Information Requested:From �''I'-•/`I to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> L3 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITYNmICLE <br /> C3 OTHER CLEANUP SITE(NON-LOP) 0 Fool)FACILITY C3 WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL. 0 DAIRY <br /> D HAZARDOUS WASTE GENERATOR C3 CHICKEN RANCH E3WA9TEwATER TREATMENT PLANT <br /> HARED PERMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCK/YARDICHEM TOILETS <br /> 0 TATTOOIBODY PIERCING ❑POOUSPA ®LAND USE APPLICATION SITES <br /> 0 MEDICAL wmnE FACILITY „(OTHRR(PLMF SPECK <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILAULE FOR REVIEW- MONDAY Ff21DAY$:00 AM-5;OOPM - EXCWDING 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(e$). At least one`file type MUST be selected. Fax to(2 1464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact ` <br /> the EHO.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 review will be confirmed <br /> approximately ten (10)days after receipt of application. The files will be he!d for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> . 44 <br /> 3. A file that is actively be' ' <br /> ,`-worked on by F_HD staff may not be immediately available for review. A new <br /> application may be sul '7hl a n,_pe file is available. <br /> 4. Any file not returned ' i1 `vl "_as released will be reorganized by EHD staff at the expense of the <br /> applicant. Future file may require a$93.00 deposit prior to review. <br /> ENb 4342.006 <br /> 77/29104 <br /> RUSH <br />