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��—lay 11a 11:0q rHUCI- T-380 P001/001 F-970 <br /> ��AT c o r� EHD LOG NUMBER <br /> ` . IJu��I�� SAN JOAQUIN COUNTY <br /> u u L� L' ENVIRONMENTAL ILTH D ARTMENT <br /> AN 1 600 East Main St.itocktcn4, 02-3029 <br /> ,Jr�'1 4 2�i� Telephone; (209) 468-3420 Fax, (209 11 eb:www.sigov.or"dp <br /> ENVIRGINNIEN HEALTH PUBLIC RECOR A#'PLICATION <br /> PE - ' <br /> APPLICANT: );lizabeth Emmons 6 � BUSINE`S'S 1. NCY: Geological Technics Inc. <br /> ADDRESS: 1172 Kansas Avenue <br /> CITY/STATEIZIP: Modesto, CA 95351 <br /> PHONE(1): 209-522-4119 PHONE(2): FACSIMILE: 209-522-4227 <br /> TENrArIVE"APPOINTMENT DATE: Monday, .Ian 11, 2010 Time: 10 AM <br /> (Please allow 10 business days from date-of submittal-'Tenta(ive only-must be confirmed) <br /> CHECK BOX TO EXPEDITER QVE$T-$115 FEE(GASH OR CHECK ONLY)-REQUEST PRQGE$SED IN 3 l3 SINESS DAYS <br /> SIGNATURE OF APPLICADATE �J Z�I v <br /> Electronic Information: ❑List[j Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# $treot Name City <br /> Unit 1 <br /> 1, 15000 Schulte Road Tcy ;{ <br /> Ail `�t"�A <br /> ra (. <br /> 2, 14700 Schulte Road Tracy <br /> (,o <br /> 4. <br /> 5 nit 3 <br /> 6. <br /> Tnit 4 <br /> 8. <br /> ❑Unit 5 <br /> 10. <br /> Specific Date Range of Information Roquested: From A 1 dates available to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ®SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NDN-LOP) ❑FOOD FACILITY ❑WASTE TIRE v <br /> UNDERGROUND TANK(MO NITORINGIREMOVAL) DOG KENNEL DAIRY w'i pt-1 <br /> HAZARDOUS WASTE GENERATOR CHICKEN RANCH WASTEWATER TREATMENT PLANT )-5 j V <br /> ❑TIERED PERMITTED FACILITY ❑MOTEUHOTEL RIPUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBDDY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY [ OTHER(PLEASE SPECIFY) SWEEPS Data <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM•5:00PM(EXCLUDING HOLIDAYS) <br /> 4. List up 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 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 END files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The tiles 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$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> EHD USE ONLY <br /> l m444/7 <br /> p <br /> I-i'0-10 uyyyj 0 5 n r- <br /> 5- <br /> END 4$.06 I 8127109 <br />