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_ 02/22/2007 10:16 209522-l` '7 GEOLOGICAL TECHW&9 PAGE 01/01 <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> FEB 2 2 2007 FNVIRONMENTAL HEALTH DF-pARTMENT <br /> ENVIRONMENT HEALTH 304 E Weber Ave P ROor Stockton,CA 95205Z' 7 <br /> PERMIT/SERVtC$S09)468-3420]Fax: (209)464-0138 Web:www.Co.san-joaquin.ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> Jenny Weesa,Office Manager Geological Technics Inc. <br /> APPLICANT: Bu8lNESSlAGENGY: <br /> ADDRESS: 11017th Street,Modesto,CA 85354 <br /> 209- 208-522 4227 <br /> 522-4119 <br /> PHONE: FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from slate of application submittl) <br /> u CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT `(N `'��" DATE f1 <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> y , 290 N.Main Streetc M�US, L~1 ❑ Unit 1 <br /> 2 ea" <br /> .') a. sv" ❑ Unit 2 <br /> `K 4Unit 3' .V <br /> 5. saeac <br /> b. saver ' ) <br /> 7. S" 52111H Unit 4 / <br /> @, Strad <br /> s. svm ❑ Unit 5 <br /> 10, street <br /> "lilt" FA <br /> SEE BELOW ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 13 SOLID <br /> L pA `UNDER TANK(UST)CLEANUP SITE(LOP) D HOUSING ASATEMUT ❑ SWASTE VEHICLE A <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ® FOOD FACILITY <br /> UNDERGROUND TANK(MONITORINGJREMQYAL) O DDG KENNEL O DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> in <br /> a TIERED PERMITTED FACILITY D MOTEJHOTEL D PUMPER TRUCKJYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING El POOLfSPA cl LAND USE APPLICATION$ETES <br /> ® MEDICAL WASTE FACILITY D OTHER(PLEASE SPECIFY) <br /> 11, <br /> 1. List up to tan addresses In'the space above. Select the type(s)of fetes from the list above by checking <br /> the appropriate box(es). At least one file We MUST be selected. Fax t2 1209)4840138 or mail to the <br /> 6- "*** <br /> address indicated Atme. <br /> 2. END will notify the applicant if any END files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days after receipt of application. The files <br /> LA <br /> will be held for a maximum of five-business days for review. Appointments should be scheduledAV N <br /> Am <br /> accordingly. IL Al <br /> 3. A file that is actively being wo*ed on by ENI]staff may not be immediately available for review. A new <br /> application may be 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 <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 6. "TENTATIVE appointment dates must be confirmed with END staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> "42,006 <br /> s "*WE NEED COPIES OF THE UNDERGROUND STORAGE TANK UNAUTHORIZED <br /> RELEASE(LEAK)/CONTAMINATION SITE REPORT FORMS FOR THIS ADDRESS <br />