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775-254-3(4b <br /> r 21 Is os-.67P Na4son Environmental --� EHD LOG NUMBER <br /> EU, SAN JC)p,,QujN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> VIAR 2 2 2016 186E East Hazelton Avenue, Stocktor), CA 95205-6232 <br /> Telephone: (209) 468-3420 Fay: (2Q9�464-6133 Web: + v"J.sj90v.Or91eh <br /> EZ <br /> EWAROMMENTAL HEALTH <br /> PERMiTrsER'1ACE3 PUBLIC RECORDS RELEASE APPLIGATION <br /> APPLICANT: Mike Nelson ElrSNESSIR,GEliCY Nelson Enviro IAC <br /> ADDRESS: <br /> 103 Laurel Ave. CITYISTATE0P:Atwater, CA 55301 <br /> PHONE(1}: 209-769-7460 PHONE (2): FAX OR E-MAIL: mike@nelsonen°viro. <br /> Please allow 10 business days from date of application submittal for the records to be aVailable. Com <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> CHECK BOX TO EXPEDITE RECIUE�LT-$130 F (CASH OR 9HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT fly DATE / z(' <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Str t# Street Manse City <br /> 3422 E_ Mirier Ave. Stockton <br /> 2 ❑ Unit 1 <br /> 3. <br /> LCj-ti nit z <br /> 4. � I <br /> El Unit 2H <br /> $' ©Unit 3 <br /> 9-6'.t 3Hre <br /> 7. <br /> El Unit d <br /> $. <br /> ®'SiTE sYiI71GAT10N <br /> 9. <br /> 10. ❑Units <br /> Specific Date Rangeof Information Requested: From !o <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTEU`HOTEL ❑SOLID WASTE FACILITY�n(EHI LE <br /> ® <br /> OTHER CLEANUP SITE{NON-I DP} ❑Hous1NG ABATEf�ENT ❑FOOD FACILITY 2 {1IP p,' (, im <br /> L'J UNDERGROUND TANK(MONITORENGIREmoVAI' ❑WASTE TIRE ❑DAIRY,POOLISPA Lul t-- � q-1-1 <br /> Q ABOVEGROUND TANK �" ❑CHICKEN RANCHI DOG KENNEL r <br /> ®HAZARDOt3S ti1fASTl=�- ❑WASTEWATER TR;=AThd�NT PLANT <br /> MEDICAL WASTE FACILITY ©PUMPER TRUCWYARDICHEM[CAL TOILETS <br /> ®HAZARDOUS MATERIALS ❑TATTODI$ODY P{ERCING <br /> PERM CITED FACILITY <br /> �]TIERED ❑LAND USE APPLICATION SITES <br /> ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERM?RECORDS ARE AVAILABLE FOP REvIEw: MONDAY-FRIDAY 8:00 AM-5.00PM(EXCLUDING HOLIDAYS) - <br /> 1. 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 209 454-D138 or mail to the address 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 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 (1o) <br /> days after receipt of application. The files will be held for a maximum of five business nays 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 staff at the expense of the applicant. <br /> Future file reviews by the same applicarrt may require a$130 deposit;prior to review.. <br /> —BOXED AREA-EHD USE ONLY— <br /> Y-LAT (00711,a4 A- <br /> 3 r <br /> 12 records provided by Staff RPR Com plete. Staff Name: <br /> Received Time_Mar, 21. -2016— 4:40PM—No- 0606 <br />