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DATE RECEIVED • `+�l',-�gt1 EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY '` <br /> � l ENVIRONMENTAL HEALTH DEPART <br /> 05-6232 <br /> NL 104ephone: (20) 468-3420 Fax1868 East Hazelton : (209) 464-0138 Webenue, Stockton, CA 52www jgov.org/e <br /> cn1yIRO =NT�LHEAI UBLIC RECORDS RELEASE APPLICATION <br /> _ NM� ,nrcC <br /> PE�NiIT�� <br /> APPLICANT: Mike Nelson BUSINESS/AGENCY: Nelson Environmental <br /> ADDRESS: 103 Laurel AVE. CITY/STATE/ZIP: Atwater, CA 95301 <br /> PHONE (1): 209-769-7460 PHONE(2):�i1,�(�(J ✓I P(58 P nyrYd FACSIMILE:775-254-3748 <br /> Please allow 10 business days from date of application submittal for the ecords to be available. <br /> Staff will contact you to arrany6__A_"_V9-0tntment date and time to review the requested records. <br /> -'� O./`CHECK BOX TO EXPEDITE REQUE 5 F E AS HECK ON -REQUEST PROCESSED IN 3 BUSINESS DAYS—, <br /> SIGNATURE OF APPLICANT DATE July 9, 2014 <br /> Electronic Information: ❑ List❑ Mop—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ' <br /> 125unit <br /> �r E. Main St. Ripon 5._7 �z y i a,u Un <br /> 2. > <br /> \� 3. Addres is listed in the Hazardous Subst nces F1 unit2 <br /> 4. Storage Container (HIST UST) and the atewide Environ ental �! 7 <br /> 5. Evaluat on and Planning System (SWEE S) databases fc r <br /> ICJ unit 3 <br /> 6. Cal-Pac fic Food Sales. This may be inc rrect as this add ess <br /> 7• was the ffice location for Cal-Pacific. T in to confirm Unit 4 <br /> 8. if the tan s were located elsewhere. <br /> 9 ❑Unit 5 <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From 1983 to pmBent <br /> rLyyry ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHIPLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE uy% fi1P5 foe- <br /> [Z UNDERGROUND TANK(MONITORINGIREMOVAL)D< ❑FOOD FACILITY ❑DAIRY (L7 f 3. 7 /If-t <br /> y <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ❑HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List uo 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!2091464.0138 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(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 staff at the expenseof the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. 'BOXED AREA-EHD USE ONLY' <br /> c� -7.1,05 <br /> 17 <br /> r <br /> ❑ Records provided by Staff-P R Complete. staff Name: <br /> EHD 48A8.1-IM.IU' 1 <br /> y � P 457 e For 1 S. n . 5 a1 5�i 081 <br />