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01-10-'13 15:26 FROM-Geological Technics T-877 P0001/0001 F-328 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAUIN COUNTY <br /> R E(3%E�! " E D ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> JAN 10 2013 Telephone: (209)468-3420 Fax: (209)4640138 Web: www"sjgov:orglehd <br /> ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> F?EQAAI—,1011 o,anr�+ <br /> APPLICANT: Jenny Weese BUSINESS/AGENCY: Geological Technics <br /> ADDRESS: 1172 Kansas Avenue CITYISTATE/i Modesto, CA 95351. <br /> PHONE(1). 209-522-4119 PHONE(2): FACSIMILE: 209-522-4227 <br /> TENTATIVE'"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*TenfaUve only-must be confirmed) <br /> El CHECK BOX TO EXPEDITE REQ EST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 qUSINEss DAYS <br /> SIGNATURE OF APPLICANT " ��Q.Q!z cam-• DATE 1 b 13 <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit 1 <br /> �v 1. 2996 McHenry Avenue Escalon t � lAlt�J <br /> ZU1 2. 3000 McHenry Avenue Escalon I Unit 2� <br /> 3. <br /> 4. <br /> Unit 3 <br /> I <br /> 6. p Unit 4 <br /> 7. <br /> ❑Unit 5 I <br /> 10. � <br /> ❑Unit t3 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACIuT1Y'NEHICL <br /> OTHER CLEANUP SITE(NON-LOP) E]HOUSING ABATEMENT ❑WASTE TIRE !il5 r I <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) E]FOOD FACILITY ElDAIRY ) )F-J <br /> "ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARoous WASTEMAZARDOUS MATERIAL ❑MOTEUHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ❑COMPLAINTIRESPONSE RECORDS RICITHER(PLEASE SPECIFY) 3v3 rc Q S <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. Fa_A to 208 464-0138 or mail to the address indic ted 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$125 deposit prior to review. <br /> V! 1122 <br /> AM <br /> .a.4 x:414<...•i1:,fha. r. <br /> ..> _ 1y _ - ! .. m.. la',sQ'��i 6N•� ,q?•.kcaSl>if!: <br /> EHD 48.06 914112 <br /> Received Time n.'102013 3:28PM No. 208 <br />