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10-24-'11 13; 15 FROM-Geological Technics T-519 P0001/0001 F-881 <br /> �' D EHD LOG NUMBER <br /> �Y SEI SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 0 2 4 2111 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax., (209) 464-0138 Web:www,sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:Cher Tonge/Elizabeth Ercuuons/Jenny Weese BUSINESS/AGENCY: ceological Technics Inc. <br /> ADDRESS: 1172 Kansas Avenue CITY/STATE/ZIP: 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-*Tentative only-must be confirmed) <br /> Q CHECK BOX TO EXPEDITE REQUEST-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit 1 <br /> 1, 1691 Frewert Road LathropG� u0 1 t <br /> 2 1601 W Frewert Road (AKA Frewart) Lathrop I} WC Unif 2 <br /> 4. ' <br /> 5. <br /> 6 Unit 4i! <br /> 7. <br /> ❑Unit 5- <br /> 9. <br /> 10. <br /> Q Uni <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> POTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> OUNDERGROUND TANK(MONITORINWREMOVAL) I ❑DOG KENNEL ❑DAIRY <br /> F'HAZARDpUS WASTE GENERATOR D�, ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOO/1300Y PIERCING ❑POOL/SPA -RIAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 'OTHER(PLEASE SPECIFY) (5A)ae5�0'-+ trq e1�(:(•A 0!5Ft)n__ � <br /> WELL AND SEPTIC PERMIT REcOROS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8: 10 AM-5:OOPM(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)464-0138 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 now 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$122 deposit prior to review. <br /> EHO USE ONLY <br /> ID <br /> EHD 48-06 07/29110 <br />