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04-26-'11 22;27 FROM -Geological Technics <br />T-251 P0001/0001 F-988 <br />DATE RECEIVED SAN JOAQUIN COUNTY <br />9 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main St. Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www,sjgov.org/ehd <br />EHD LOG NUMBER <br />VVP a1`a PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Emmons/Jenny Weese BUSINESS/AGENCY: Geological Technics Inc_ <br />Modesto, CA 95351 <br />I ansls�venue CITY/STATE/ZIP: <br />PH (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-'Tent0ve only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST - $122 F <br />SIGNATURE OF APPLICANT <br />Electronic Information: List ❑ Map — Des <br />FILE ADDRESS <br />(CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />DATE V-2-1111 <br />ption: <br />Street # <br />Street Name <br />City Unit 1 <br />1 2771 <br />French Camp Road <br />Manteca <br />❑ Unit 2 <br />3. <br />Unit 3 <br />4. <br />S. <br />Unit 4 <br />6. <br />7. <br />❑ unit 5 <br />8' <br />9. <br />❑ Unit <br />10. <br />Specific Date Range of Information Roquosted: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES f C' fKtJl �/ <br />D UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYIVEHICLE <br />© OTHER CLEANUP SITE (NON -LOP) © FooD FACILITY ❑ WA$TE TIRE <br />D UNDERGROUND TANK (MONITORING/REMOVAL) Q\ ❑ DOG KENNEL ❑ DAIRY <br />D HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTE=WATER TREATMENT PLANT -0 J <br />❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />❑ TATTOO/BODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY © OTHER (PLEASE SPECIFY) (Sweeps Report, Emergency or complaint calls) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILA13LE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br />1. List un 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 fife 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 some 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 />EHD USE ONLY <br />�. i . Dndtdv — -+o1 t`� -(� i ,� 9P _ .iar7l�✓11 l i > <br />