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DATE RECEIVED � P EHD LOG NUMBER <br /> (+ SAN JOAQUIN COUNTY <br /> .V99nn ENVIRONMENTAL HEALTH DEPART <br /> JULenue, Stockton, CA 9 <br /> I O- lephone: (209) 468-342868 East Haze10 F ton xV(209)464-0138 Web5205-6232 www jgov.org/e <br /> > RONMENTAL- Q11wEA 'UBLIC RECORDS RELEASE APPLICATION <br /> PE <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): Mj(ep ✓f Pr(so%Ar y\ViYo FACSIMILE:775-254-3748 <br /> C04'1 <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrang n ap en-tLdate and time to review the requested records. <br /> O(CJ-IECK BOX TO EXPEDITE REQUES� .5 F AS �OIyCHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS-, <br /> SIGNATURE OF APPLICANT (/' DATE July 9, 2014 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit <br /> 1. 125 E. Main St. Ripon -7 oz <br /> 2. r p[ 5 ❑Unit <br /> 3. Addres SIFisted in the Hazardous Substances <br /> 4. Storage Container (HIST UST) and the Statewide Environ nental VUnit3 <br /> s. Evaluat on and Planning System (SWEEPS) databases f <br /> 6. Cal-Pac fic Food Sales. This may be incc rrect as this addi ess Unit <br /> 7. was the ffice location for Cal-Pacific. T ing to confirm <br /> 8. if the tan ks were located elsewhere. ❑Unit 5 <br /> 9. <br /> 10. ❑Unit6 <br /> Specific Date Range of Information Requested: From 1983 to present <br /> rrgqryry ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Ly UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY - ❑SOLID WASTE FACIU YIVEHHIIGLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE. uy% {i JPS fo/' <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL)4 ❑FOOD FACILITY ❑DAIRY 1.6n I t 3. J 7-1+a-t M <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL [-]WASTEWATER TREATMENT PLANT <br /> ❑HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL 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 Ant-5:OOPM(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)464-0138 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 expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. 'BOXED AREA-EHD USE ONLY*** <br /> Or -P.5 S <br /> ` n <br /> rAr <br /> - U 9 r <br /> n42951o <br /> ❑ Records provided by Staff-PPR <br /> Staff-PPR Complete. S@ff Name: <br /> EHD4A6.1-I -IU- <br /> . Se$ <br /> Tr ".p451 �/ a1�4 <br />