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01-14-'13 14:06 FROM-GeOlogical Technics T-879 P000110001 F-338 <br /> DATE RECEIVED U EHO LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> (Q1868 East Hazelton Avenue, Stockton, CA 95205-6232 ^ `� <br /> q Dibphone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd \ \`_` ✓✓✓ <br /> N00L*UBLIC RECORDS RELEASE APPLICATION <br /> ��.yy M�°Anny Weese Geological Technics <br /> APPL�1Lgt�F: Y BUSINESSIAGENCY: I` <br /> ADDRESS: 1172 Kansas Avenue CITY/STATE/ZIP: Modesto, CA 95351 <br /> PHONE(1): 209-522-4119 PHONE(2): FACSIMILE: 209-522-4227 <br /> TEl T/VESAPPOINTMENTDATE: Time: <br /> (Please allow 10 business days from date or application submittal-'Tentative only.must be confirmed) <br /> ❑CHECK BOXTO EXPEDITE REQt EST-$125 FEE,( SH OR CHECK ONLY)•REQUEST PROCESSED IN 3 BPSINIi <br /> SIGNATURE OF APPLICANT DATE I I I )"3 k <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS END USE ONLY <br /> Street# Ill Nam® city ❑Unit 1 <br /> 1. 20001 McHenry Avenue Escalon <br /> 2. 19901 McHenry Avenue Escalon <br /> ❑Unit 2 <br /> 3. <br /> 4. <br /> E]Unit 3 <br /> 5. !-Re- �n4rl°& <br /> 6 1A k / <br /> / tt E Unit4 <br /> 7 <br /> 8• ❑Unit S <br /> 9. <br /> 10. ❑Unit B <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENTFILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) - ` ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> ®OTHER CLEANUP SITE(NOR-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ®ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> �HAzARnous WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS [A OTHER(PLEASE SPECIFY) SvJ S <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 5:00 AM-5:00PM(EXCLUDING HOLIDAY <br /> 1. 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(as). At least one fila type MUST be selected. Fax to(2091464.0138 or mall to the address indicated above, Address i <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 END will notify the applicant if any END files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will he held 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 END staff may not be immediately available for review. A new application may be <br /> submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> a <br /> END 48.98 - 9!4!12 <br /> Received Time Jan. 14. 2013 2:08PM No, 2101 <br />