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01-04-' 10 11:I64 rHUM- T-380 P001/001 F-970 <br /> DA7 c I ED EHD LOG NUMBER <br /> (�.,' ` SAN .IOAQUIN COUNTY <br /> U11I� f �Ll L'JJ ENVIRONMENTAL HEALTH D ARTMENT <br /> 600 East Main SV Stockton, 02-3029 <br /> jAN 4 201.0 Telephone; (209) 468-3420 Fix: (209 $ eb:www_sjgov.org/e d <br /> 4:' T <br /> ENVIRONNEN I HEALTH PUBLIC RECORPA E APPLICATION <br /> P EflifIME n' <br /> APPLICANT: Elizabeth Emmons �` .gggI SJAGENcy: Geological Technics Inc. <br /> ADDRESS: 1172 Kansas Avenue "`Cl . 40 Modesto, CA 95351 <br /> �s�� <br /> PHONE(1): 209-522-4119 PHONE(2); FACSIMILE: 209-522-4227 <br /> TENTArIVE"APPOINTMENT DATE: Monday, Jan 11, 2010 Time: 10 AM <br /> (Please allow 10 business days from date of application submittal-'Tentafive only-must be confirmod) <br /> CHECK eOX TO EXPEDITER QUEST-$115 FEE(GASH OR CHECK ONLY)-REQUEST PROCESSED 1N 3 B SINESS DAYS <br /> SIGNATURE OF APPLICANT` \,z9-6.� DATE <br /> Electronic Information: ❑List❑ Map-description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Streot Namo City El Unit 1 <br /> 1. 15000 Schulte Road Tracy <br /> 2, 14700 Schulte Road Tracy �� / `��� 4t2 <br /> 3 <br /> 4. ni <br /> 5. <br /> 6. <br /> nit 4 <br /> 7. <br /> $. A� ❑Unit 5 <br /> 10. Unit 6 <br /> Spocific Date Range of Information Requosted. From All dates available to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ®SOLID WASTE FACILITYIVEHICLE <br /> ?�OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOOBODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICALWASTEFACIUTY [A OTHER(PLEASE SPECIFY) SWEEPS Data <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM•5:00PM(EXCLUDING HOLIDAYS) <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(es). At least one file type MUST be selected. Fax to(209)464-0136 or mail 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 /> 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 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 EHD 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 EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> EHD USE ONLY <br /> EHD 4 .06 8127109 <br />