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03-28-'12 09:47 FROM -Geological Technics T-662 P0001/0001 F-318 <br />DATE RECEIVED 4 <br />EHD LOG NUMBER <br />SAN JoAQu�N Cc�uNTY <br />ENVIRONMENTALHEALTH-DEPART ENTIft <br />BAR ��1 600 East Main St, Stockton, CA 95202-3029 <br />elephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />ENNYMNMENTA( HEALTH PUBLIC RECORDS RELEASE APPLICATION <br />PERMIT/SERVICES <br />APPLICANT: Elizabeth Errunons/Jenny weese BUSINESSIAGENCY: Geological Technics Inc. <br />ADDRESS: 1173 Kansas Avenue CITY/STATE/ZIP: Modesto, CA 95351 <br />PHONE (1): (209) 522-43,1.9 PHONE (2): FACSIMILE: (209) 522-4227 <br />TENTATIVE" APPOINTMENT DATE: Time: <br />(Please allow 10 business days from dote of applicatlon submittal • "Tentative only, must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST - $122 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT <br />Electronic Inforrnatlon: 0 List ❑ Map — Description: <br />ME <br />Il AGIUW WI IIIIUF111pu Vn meyuuslco: rrom to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES r <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT/ `I ✓�� <br />❑SOLID WASTE FACILITYNEHICLE � <br />® OTHER CLEANUP SITE (NON -LOP) ® FOOD FACILITY <br />El UNDERGROUND TANK (MONITORING/REMOVAL) ❑DOG KENNEL El WASTE TIRE f opt,, t <br />Q HAZARDOU$ WASTE GENERATOR ❑ CHICKEN RANCH El DAIRY <br />W" <br />El TIERED PERMITTtcD FACILITY ❑ WASTEWATER TREATMENT PLANT <br />❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEMICAL TOILETS <br />El TATTOO/BODY PIERCING ❑ POOL/SPA <br />❑ 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:OOPM (EXCLUDING HOLIDAY8) <br />1. List UP to ten addresses In the space above. Select the typo(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) 464.0135 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 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 />