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1234 KLEINFELDER 1:14 06-29-2010 1 !1 <br /> DATE RECEIVED EH �LOGNUIVIBE <br /> I p 60 Qj IN COUNTY <br /> L� !ENT-I EALTH DEPARTMENT <br /> ckton, CA 95202-2708 <br /> 0 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/eh <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> i BUSINESS/AGENCY: <br /> ADDRESS:— -CITY/STATE21P <br /> PHONE(1): '577- 4351 PHONE 12): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE'_ Time: <br /> (Please allow 10 business days frdat of 11 ation submittal-*Tentative only-must be confirmed) <br /> i <br /> CHECK BOX TO EXPEDITE REQUEST-1115. 0�jEIE( R CK ONLY)-REQUEST PROCESSED IN 3 BUSIN YS <br /> SIGNATURE OF APPLICANT 1117 DATE <br /> 11 <br /> Electronic Information: 0 List E] Map-Description: <br /> FILE ADDRESS END USE ONLY <br /> —Strom Nam-- city <br /> a* 5iog&o <br /> 2. Unit <br /> 3. <br /> 4. unit <br /> 6. <br /> ke <br /> 6. 0Unit 4 <br /> 7. 14A Unit 5 <br /> 9. LA I lvnUnit 6 <br /> WCD/'�' 1, F <br /> I <br /> un—its <br /> pay P') <br /> Specific Date Range of Information Requested: From W-'Wc — to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES hk�A( <br /> .0`UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 17)HOUSING ABATEMENT fflOLID WASTE FACIUTYTVEHICLE <br /> P-OTHER CLEANUP SITE(NON-LGP) 0 F000 FACILITY 13 WASTE TIRE <br /> DERGROLIND TANK(MONITORINGIREMDVAL) El DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR E3 CHICKEN RANCH OVASTEWATER TREATMENT PLANT 0 <br /> 0 TIERED PERMITTED FACILITY 0 MOTELIHOTEL 13 PUWERTRucK/YARDICHEuTcHLETS <br /> 0 TATtOOIBODY PIERCING 13 POOLISPA MIA-ND USE APPLICATIONSITES <br /> 0 MEDICAL WASTE FACILITY El OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW-MONDAY481DAY 8:00 AM-5:00pm - EXCLUDING HOLIDAYS. <br /> 1. List up to ton 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 assIsta? N <br /> le0dwes contact the END.Applications received after <br /> 3:00 pm will be processed the next business day. <br /> riArie <br /> Z The END will notify the applicant If any END files Ox'st'& <br /> .Ii'An,ppolit"ent Iii w will be confirmed approximately ten(10) <br /> days after receipt of application. The files will beheld for a maximum"Of fiVe 6U51ness days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A Rio that Is actively being worked on by END staff may not be Immediately available for review. Anew application maybe <br /> submitted when the Rio Is available. <br /> 4. Any file not returned In the Sam*condition as released wit be reorganized by END staff at the expense of the applicant. <br /> Future file reviews by the some applicant may require a$105.00 deposit prim to review. <br /> END USE ONLY <br /> ***If you need further assistance please contact Diane Martinez @ (209)468-3425 daireCTly. Thank You" A' <br /> I <br /> n4o(Lkn dWA10 to.- P 40 OA). -MiIk�1 � <br /> h le <br /> W <br /> L-1 JO 1 (40M <br /> YA�11 <br />