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12-15-'08 15:56 FROM- T-489 P001/001 F-092 <br />DATE RECEIVED �n� EHD LOG NUMBER <br />TE SAN JOAQUIN COUNTY _i <br />��E�'�% �IJ ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 952029 <br />�F=� O LOOK Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: m -302sjgov.o <br />ENVIRONMENT HEALTH pUBLIC RECORDS RELEASE APPLICATION <br />DFD A A:T to rn, TTrI��� <br />APPLICANT: Elizabeth Emmons BUSINESSIAGENCY: Geological Technics Inc. - <br />ADDRESS: 1101 7th Street Modesto CA 95354 <br />PHONE (1): (209) 522-4119 PHONE (2): FACSIMILE: (209) 522.4227 <br />TENTATIVE" APPOINTMENT DATE: Time: <br />'''r���AA, (Please allow 10 business days from date application submittal - `Tcnfarive only • must be confirmed) <br />+, CHECK BOX TO EXPEDITE REQUEST • E�I}V! ,EE (C SHS AORR CH K ONLY) -REQUEST PROCESSED IN 3 B SIN SS DAYS . . . . . <br />/AT-UREOF APPLICANT `?/YIGLI/OY/ l � <br />SIGN %�%�Y%� DATE tgll () <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />ENVIRONMENTAL <br />Street# Street Name <br />City <br />❑ Unit 1 <br />0 <br />1. <br />3932 Budweiser Court <br />Stockton5 <br />2• <br />13 FOOD FACILITY <br />OWASTE TIRE <br />❑ Unit 2 <br />3. <br />Cl DOG KENNEL <br />❑DAIRY <br />4, <br />&A <br />Cl CHICKEN RANCH <br />Unit 3 <br />5. <br />G TIERED PERMITTED FACILITY <br />❑ MOTELIHOTEL <br />4 <br />s.Unit <br />0 TATTOOIBODY PIERCING <br />E3 POOUSPA <br />T. <br />13 MEDICAL WASTE FACILITY <br />❑ Unit 5 <br />13. <br />9. <br />❑ unit e <br />10. <br />Specific Date Range of Information Requested: From <br />to <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT FILESj`j <br />NDERGROUND TANK (VST) CLEANUP SITE (LOP) <br />❑ Housoia ABATEMENT <br />❑ SOLID WASTE FACILITYIVEHICLE <br />Wf l �' 3 • ,/ <br />THER CLEANUP SITE(NON-LOP) <br />13 FOOD FACILITY <br />OWASTE TIRE <br />f <br />Cl DOG KENNEL <br />❑DAIRY <br />93NDERGROUNOTANK(MONITORINGIREMOVAL)V- <br />ZARDOUe WASTE GENERATOk <br />Cl CHICKEN RANCH <br />O WASTEWATER TREATMENT PLANT <br />G TIERED PERMITTED FACILITY <br />❑ MOTELIHOTEL <br />O PUMPER TRUCKIYARDICHEM TOILETS <br />0 TATTOOIBODY PIERCING <br />E3 POOUSPA <br />M LAND Use APPLICATION SITES <br />13 MEDICAL WASTE FACILITY <br />Q OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMITRECORDS ARE AVAILABLE FOR REVIEW -MONDAY-FRIDAYS:ODAM-5:00PM - EXCLUDING HOLIDAYS. <br />t. List up to ten 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 (2091464.0138 or mail to the address indicated above. Address <br />ranges will not be accepted —for additional assistance with file addresses, contact the END. Applications received after <br />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 approximately ten (10) <br />days after receipt of application. The files will be hold for a maximum of five business days for review. Appointments <br />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 application may be <br />submitted when the file is available. <br />4. Any RIs not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br />Future file reviews by the same applicant may require a $98.00 deposit prior to review. <br />EHD USE ONLY <br />