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01-14-' 13 14;06 FROM-Geolog-Lual Technics T-879 P0001/0001 F-338 <br /> DATE RECEIVED EHD LOG NUMBER <br /> •- SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> �� •� 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> I`ephone (209) 468-3420 pax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ,,kAePO ELIC RECORDS RELEASE APPLICATION <br /> Geological Technics <br /> APPLIGg1 :�`� "Fenny Wee a BUSINESS/AGENCY: <br /> ADDRESS: 1172 Kansa's Avenue CITY/STATE/ZIP: Modesto, CA 95351 <br /> PHONE(1): 209-S22-4119 PHONE(2): FACSIMILE: 209--5224227 <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 urinous days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK E3( EXPEDI E REQt1EST-$125 FELE(QASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 B SIINSS DAYS <br /> SIGNATURE OF APPLICANT S -' 0ATE I 1 y 13 <br /> Electronic Information: ❑List ❑ Map-Description: /N <br /> FILE ADDRESS EHD USE ONLY <br /> Street ii Street Namo City i `Unit 1 <br /> nJJ 1. 20001 McHen y Avenue Escalon 0- � <br /> wJ� 2. 19901 McHenry Avenue Escalon ]Unit z <br /> 3. <br /> ❑ <br /> 4. Unit 3 <br /> _ 6 IJ Unit 4 <br /> 7. ' <br /> 13 To view the HMMP(Hazardous <br /> 3 9 Materials Management Plan)go to the I:]Unit s <br /> following website:www.sjoesdata.org <br /> 10. ]Unit 6 <br /> -.Specific Date Range of Information aquested: From �v <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILM.Y�VEHICI,F, J ` <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MON ITORI NGIREMOVAL)Vj- ❑FOOD FACILITY ❑DAIRY Yjt- 2 <br /> ABOVEGROUND TANK �}- ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> Z C'j <br /> HAZARDOUS WASTEMAZARDOUS MATERIAL ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEMICALTOILETS <br /> I�RED PERMITTED FACILITY ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> jT00IBODY PIERCING ❑COMPLAINT/RESPONSE RECORDS [ OTHER(PLEASE SPECIFY) S\A 5 <br /> < ELL AND SEPTIC PERMIT RECpRDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> TIT <br /> List up to ten addresses In tete space above. Select the type(s)of files from the list above by checking the appropriate <br /> q ox(es). At least one file type MUST be selected. Fax to(209)464.0138 or mall to the address indicated above, Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 53:00 pm will be processed the next business day. <br /> 11 �The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> �ldays after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> `-` �A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> Jcsubmitted when the file is available. <br /> Z_ �ql-Any file 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$125 deposit prior to review. <br /> n� <br /> EHD 46-05 r I ?-l3' <br /> Received Time Jan. 14. 2013 2: 08PM No. 2101 L t_ ��f ��������i/�b (�f�t� <br /> ... <br />