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05-02-'11 20;50 FROi'1-Geological Technics T-260 P0001/0001 F-005 <br /> REGEIV, FD EHD LOG NUMBER <br /> SAN .�OAQUIN COUNTY <br /> MAY 0 3 2011 ENVIRONMENTAL HEALTH DEPARTMENT m <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> ENVIRONMENTAL HEALTHTOIephone: (209) 4683420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Elizabeth 2mmons/Jenny weese BUSINESS/AGENCY: Geological Technic; Inc. <br /> ADDRESS: 1173 Kansas Avenue CITY/STATE/ZIP: Modesto, CA 95351 <br /> PHONE(1): (209) 522-4119 PHONE(2): FACSIMILE: (209) 522-4227 <br /> TENTATIVE*APPOINTM ENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU INESS DAYS <br /> SIGNATURE OF APPLICANT �� ,�, , � 1 DATE <br /> Electronic Information: [A List❑ Map—description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Narria City <br /> ' Q Unit 1 <br /> V 2638 French Camp Road e) , Manteca A'O �� <br /> V 3945 'v <br /> 2. R French Camp Road Manteca <br /> '' r ❑Unit 2 <br /> 3. <br /> 4. <br /> Unit 3 <br /> 5. <br /> 6. <br /> Unit 4 <br /> 7. <br /> 8. <br /> ElUnit 5 <br /> 9. <br /> 10. <br /> ❑Unit <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES -� I <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(IAP) ❑HOUSING ABATEMENTPy <br /> ❑SOLID WASTE FACILITYNEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ©FOOD FACILITY ❑WASTE TIRE . <br /> I/ n 2� <br /> x❑UNDERGROUND TANK(MONITORING/REMOVAL�Vv< ❑DOG KENNEL El DAIRY VU '1 <br /> d HAZARDOUS WASTE GENERATCROj \� [I5 <br /> CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT ' r/1 <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ©OTHER(PLEASE SPECIFY) (Sweeps Report, Emergency or complaint calls) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List tip 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. F%ix 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 1i u) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should he scheduled accordingly. <br /> 3. A file that is actively being worked on by EHID staff may not be immediately available for review. A new application <br /> 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 of the apple; <br /> Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> EHD USE ONLY <br /> Y, 00_) " r aq - <br /> c <br /> EHD 48.06 07129110 <br />