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BATE RECEIVED (AN JOA UlN COUNTY <br />41 Cnv Lug Nuna:K <br />RDEk`DE D E�ROMMNTAL AI.TH DFPARTMFNT <br />304 East Weber Avenue, 37d oil, CA 95202-270$ -90-00001 <br />F� B � .7 2006 'Telephone: (209) 468-3420 Fax {209) 464-0t3 Web: www,pjgoy.org/chd <br />. <br />r -mm ala U T HFAI_TH____ _ PUBLIC RECORDS RELEASE APPLICATION <br />N <br />4e BUSINESSIAGENCY: <br />ADDRESS: <br />PHONE (1): �.�, PHONE (2):Ae ' FAcsiMll"s: <br />TENTATIVE* APPOINTMENT DATE: A , f A1-1 <br />(Please allow 10 business days from date of application submittal-•Tenfallve only -must be confirmed)� <br />EI CHECK BOX TO ExpEorm REQUES - 3.00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED -IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DAVE t.•J-7-%2 <br />UNIT DISTRIBUTION d Unit 1 0 Unit 2 0 Unit 3 Q Unit 4 1 Unit 5 O Unit 8 Ca Other (e{eotrmIcflI9WMaps) <br />FILE ADDRESS -- �� 1EHD USE ONLY <br />Street street Name <br />Specific Date Range of Information Raquested: From _ . to V <br />CI UNDERGROUND TANK (UST) CLEANUP $ITE (LOP) Q HOUSING ABATEMENT O SOIM WA3TE FACIUTYNEHICLE <br />D ®TMER CLEANUP SITE (NON4-OP) CI FOOD FACILITY 0 WASTE TIRE <br />® UNDERGROUND TANK (MAONITORINOMEMOVAL.) 0 DW KENNEL p DAIRY <br />® HAZARDOUS WASTE (3EMOMTOR 0 CHICKEN RANCH O WASTEwATFR TREATMENT PLANT <br />O TIERED PERMW= FACILITY ❑ MoTr=LMOT6L ❑ PumpeR TRVCKiYAWCNEM Totmw <br />O TATTOOMMY PIERCING 0 POOLISFAE3 LAND AND APPLicAnoN Srms <br />13 Mt:[wcAL. WASTE FACIE rry ® OTHER (PLEASE SPECIFY) i..I f yy� �' <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE POR REVIEW - MONDAY-FIRWAY 8:00 A1A�,i;0�''POFNE' - EXCLUDING HOLIDAYS. <br />I. List up to ten addresses in the space above. select the type(s) of tiles from the list above by checking the <br />appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address <br />indicated above. Address ranges will not be accepted -for additional assistance with file addresses, contact <br />the EHD. Applications received atter 3:00 pfn will be processed the next business day. <br />2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confinved <br />Approximately ton (10) days after receipt of application. The files will be held for a maximum of fivo busine$s . <br />days for review. Appointments 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 <br />application may be 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 expel nse of the <br />applicant, Future file reviews by the same applicant may require a $93.00 deposit prior to review, <br />ENA 484244 <br />ii1221a4 <br />