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02/22/2007 10:16 209522 4117 GEOLOGICAL TECHF` PAGE 01/01 <br />EHD LOG NUMBER <br />DATE RECEIVED SAN JOAQUIN COUNTY <br />FEB 2 2 2007 FNVIRONMNTAL HEALTH DF-PAETMENT <br />ENVIRONMENT HEALTH 304 E Weber Ave P Phot Stockton, CA 95205 <br />PERMIT/SEMVjC 09) 468-3420 Fax: (209) 464-0138 Web: www.co.sanjo i0.ca.u$/ehd <br />Pi1BLIC RECORDS RELEASE APPLICATION <br />Jenny Weess, Oiflce Manager Geological Technics Inc. <br />rakeAftn.— 11 <br />APPLICANT: _ BUSINESSIAGENCY: <br />1 7 rvt'th Street Medesto. CA 95354 _ <br />ADDRESS: <br />PHONE: <br />209-522-4119 FACSIMILE: <br />zva-aee vim" -- <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 bualness daps from dale of aPPllcatlon submittal) <br />In CHECK BOX TO EXPEDITE REQUEST' $93.00 FEE - REQUEST PROCESSED IN 3 BUSINESS DAYS 1 �� <br />SIGNATURE OF APPLICANT DATE I <br />Department Use Only <br />SEE BELOW ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNIT <br />d Unit 1 <br />❑ Unit 2 <br />Unit 3 , V <br />Unit 4 <br />❑ Unit 5 <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />® HOUSING ASATFMENT <br />O SOLID WASTE FAC <br />w <br />OTHER CLEANUP SITE (NON -LOP) <br />CI FOOD FACILITY <br />VEHICLIUTE <br />d SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORINGIREMOVAL) <br />17 DOG KENNEL <br />O DAIRY <br />O PKG TREATMENT PLANT 11111%6IL <br />17 HAZARDOUS WASTE GENERATOR <br />O CHICKEN RANCH <br />13 PUMPER TRUCKIYARDICHEM TOILETS <br />D TIERED PERMITTED FACILITY <br />O TATTOOIBODY PIERCING <br />D MOTEL1HOTEL <br />O POOLISPA <br />M LAND USE APPLICATION SITES <br />® MEDICAL WASTE FACILITY <br />13 OTHER (PLEASE SPECIFY) <br />1. List up to ten addresses In'the space above. Select the type(s) of files from the list above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax f2 12091464-0138 or mail to the <br />address indicated Ve. <br />2. EHD will nobly the applicant N any EHD 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 LA <br />will be held for a maximum of five -business days for review. Appointments should be scheduled <br />accordingly. y by not be immediately available for review. A new <br />3. A file that is actively teeing worked on EHP staff may <br />application may be submitted when the file is available. <br />4. Any file not returned in the same condttlon as released will be reorganized by END staff at the expense <br />of the applicant. Future file reviews by the some applicant may require a $93.00 deposit prior to review. <br />5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br />6. Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE Tim . <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />4"1 -NO <br />8l8oOS <br />"* WE NEED COPIES OF THE UNDERGROUND STORAGE TANK UNAUTHORIZED <br />\ RELEASE (LEAK) /CONTAMINATION SITE REPORT FORMS FOR THIS ADDRESS <br />