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I�"��N EHD LOG NUMBER <br /> DATE RECEIVED t� y SAN JOAQUIN COUNTY <br /> JUN L V Z011 44-'e'�)PM ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 86536 <br /> �Atf��i : (209)468-3420 Fax: (209)464-0138 Web:www.sicehd.com Email: infoc&sicehd.com <br /> PEAEdfiISERr/tC S PUBLIC RECORDS RELEASE APPLICATION <br /> &PPLICANT: Paul Parker BUSINESS/AGENCY: Hopf Environmental <br /> ADDRESS: 10356 N Country Rd 950 E CITY/STATE/ZIP: Brownsburg, IN 46112 <br /> PHONE (1): 317-677-2960 PHONE (2): FAX OR E-MAIL: parker@envirohopf.com <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Processed via email by staff. Dom M DATE June 21,2017 <br /> 1. List up to ten addresses in the space below. Address ranges will not be accepted. Select the type(s)of files from the list <br /> below by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138, mail to the <br /> address indicated above, or email to info(a)sicehd.Com. Applications received after 3:00 pm will be processed the next <br /> business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. <br /> 3. 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. q <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. �'21 <br /> \ Future file reviews by the same applicant may require a $139 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map— Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> FILES <br /> ®UNDERGROUNO TANK(UST) Street# Street Name city <br /> CLEANUP SITE(LOP) 0ILI ❑CONSUMER <br /> OTHER CLEANUP SITE(NON-LOP) S 192 Lathrop Rd Lathrop It/ <br /> ®HAZARDOUS WASTE \f, ❑DAIRY <br /> ®TIERED PERMITTED FACILITY O 14090 E Hwy 88 Lockefordo / ^� <br /> ®ABOVEGROUND TANK r f 110 V L/ <br /> ®UST (MONITORING/REMOVAL) �2 / ❑PWS <br /> ® a 1434 W Yosemite Ave Manteca 71 "ur /� ,L <br /> HAZARDOUS MATERIALS r✓/ rfyTl (,o <br /> SPILL/RELEASE RESPONSE <br /> ®WATEfl QUALITY <br /> SOLID WASTE FACILITY/VEHICLE 4 <br /> ❑FOOD FACILITY <br /> POOL I SPA l�1 ®SITE MITGA70N <br /> DAIRY 6 0r hs <br /> LAND USE APPLICATION SITES 11Vr{/--^��IJ HOUSING <br /> E]SEPTIC PUMPERTRUCK 1 6 I 1 `N Y4 GAJ <br /> YARD I CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT OO I• ®CUPA <br /> HOUSING ABATEMENT r —jam <br /> MOTEL/HOTEL ( , <br /> ®CUPA-UST <br /> CHICKEN RANCH/DOG KENNEL <br /> 8 <br /> MEDICAL WASTE FACILITY <br /> TATfOO(BODY PIERCING SOLID WASTE <br /> ❑WASTE TIRE 9 <br /> ®COMPLAINT <br /> ❑OTHER(PLEASE SPECIFY): ACCOUNTING <br /> TO <br /> "'BOXED AREA-EHD USE ONLY- <br /> 6/2112017—Emailed applicant to confirm receipt of application. Dom M <br /> 0 Records provided by Staff-PPR Complete. Staff Name: <br />