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ECVEV SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> NOV 0 )i 2016 ENVIRONMENTAL HEALTH DEPARTMENT q00 1: (2 East Hazelton Avenue, Stockton, CA b:ww 623Telephone: (209)468-3420 Fax; (209)464-0138 Web:www,sjgov.org/ehd jvRJvti yV� <br /> ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT. MlChael Parl SI BUSINESS/AGENCY: Carpenter CO <br /> ADDRESS: _ 1710 South Harlan Road CITY/STATE/ZIP; athrQR_-CA 953 <br /> PHONE (1): 209_982_4800 PHONE (2): FAX OR E-MAIL: <br /> Please allow 10 busiys from date of application submittal for the records to be available, aricciQr^rnani <br /> ness da <br /> Staff will contact you to arrange an appointment date and time to review the request0Aords. <br /> ❑ CHECK BOX TO EXPEDITE MZW <br /> SHQ2CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTDATE1. List uoto ten addresses in the ow. Select the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464.0138 or mail to the oddress indicated above Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records,please contact E D 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. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD sta f at the expense of the applicant. <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 M-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: EXList❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> �UNDEftGR0UN0 TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) <br /> 17100 S. Harlan Road Lathrop ElComMER <br /> �OTXER CLEAN UP SITE(NON-LOP) <br /> ❑HAZARDOUS WASTE <br /> TIERED PERMITTED FACILITY y DAIRY <br /> ABOVEGROUND TANK <br /> [RUST (MONITORING/REMOVAL) []PWS <br /> ❑HAZARDOUS MATERIALS 3 <br /> SPILL/RELEASE RESPONSE <br /> SOLID WASTE FACILITY/VEHICLE 4 Ni'WATER QUALITY <br /> FOOD FACILITY <br /> POOL/SPA <br /> DAIRY 5 Q SITE MITIGATON <br /> LAND USE APPLICATION SITES <br /> ❑SEPTIC PUMPER TRUCK/ []HGU9ING <br /> YARD I CHEMICAL TOILETS S <br /> WASTEWATER TREATMENT PLANT <br /> HOUSING ABATEMENT r <br /> CUPA <br /> MOTEL/HOTEL <br /> CHICKEN RANCH/DOG KENNEL CUPA-UST <br /> MEDICAL WASTE FACILITY R <br /> TATTOO/BOOT PIERCING <br /> ❑WASTE TIRE O SOLID WAST£ <br /> 9 <br /> COMPLAINT <br /> F-1 OTHER(PLEASE SPECIFY): <br /> TO ❑ACCOUNTING <br /> -BOXED AREA-EHO USE ONLY^ <br /> ❑ Records provided by Staff-PPR Complete. SUN Name: <br /> EHD 48-06 <br />