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V'j 1G V,7 9r rnUj'1 Lje0 1"0 al iecimics T-662 P0001/0001 P-318 <br /> DATE RECEIVED vl EHD LOG NUMBER <br /> RECEIVESAN JOAQUIN COUNTY <br /> ENWRONMENTAL HEALTM.DEPARTMENT <br /> MAR201 600 East Main St. Stockton, CA 95202-3029 1 <br /> elephone: (209)468-3420 Fax: (209) 464-0138 Web: www,sjgov.org/ehd <br /> ENMNMENTAWEA1111 PUBLIC RECORDS RELEASE APPLICATION <br /> PER_MITiSERVIr, <br /> APPLICANT: Elizabeth Emmons/Jeririy SgGesB BUSINESS/AGENCY: GeolOgical Technics Inc, <br /> ADDRESS: 1172 Kansas Avenue CITY/STATEIZIP: Modesto, CA 95351 <br /> PHONE (1): (209) 522-4119 PHONE (z): FACSIMILE: (209) 522-4227 <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal••Tentalhs only-must he confirmed) <br /> ❑ CHECK BOX To EXPEDITE REQUEST-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCE55ED IN 3 BU91NE5S DAYS <br /> SIGNATURE OF APPLICANT_ DATE <br /> Electronic Information: E List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Slrsct Name City <br /> 1 2771 Fr©nch Camp Road Mantoca Ll Unit1 <br /> 2. <br /> 3. 1 ❑Unit 2 <br /> 4. <br /> Unit 3 <br /> s. 1A err b1+ 1� <br /> 7 nJ14 <br /> B. <br /> Uni <br /> 9. <br /> 10. <br /> QUni <br /> Specific bale Rangy of information Requefitcd; From to <br /> ENVIRONMENTAL HEALTH bEPARTMENT FILES " <br /> Q UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT <br /> ® <br /> OTHER CLEANUP SITE(NON-LOP) ®FOOD FACILITY ❑SOLID WASTE FACIUTYNEHICLE <br /> [x] MONITORINGIREMOVAL ❑WASTE TIRE <br /> UNDERGROUND TANK <br /> ( } ❑DOG KENNEL F—]DAIRY <br /> Q HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH <br /> []TIERED PERMITTED FACILITY ❑WASTEWATER TREATMENT PLANT <br /> ❑MOTELIHOTEL ❑PUMPER TRUCK/yARDICHEMICAL TOILETS <br /> ❑TATTOO113ODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ®OTHER(PLEASESprorY( (Sweeps Report:, Emergency or complaint calls) <br /> WELL AND SI=PTIG PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONbAY-FRIDAY 8:00 Awl-$:GOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses In the space above. Select the typos)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-111.138 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 EMD 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$122 deposit prior to review. <br /> Eno USE ONLY <br /> EHD oaoe <br /> arizgllo <br />