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ECEIVE9 <br />SAN 100 nvironmental Health Department <br />COU N TY-- JUIL 1 b 2016 PUBLIC RECORDS RELEASE APPLICATION <br />Ni�IRONMENfAI.! l�AiT�i �-1 Vct 1 *7 5 <br />• PEf:MIT/S tti EHD LOG NUMBER. <br />APPLICANT: Mike Nelson BUSINESS/AGENCY: Nelson Enviro, LLC <br />• <br />• <br />ADDRESS: 103 Laurel Ave. <br />CITYISTATEIZIP: Atwater, CA 95301 <br />PHONE (1): 209-769-7460 PHONE (2): FAX OR E-MAIL: mike@nelsonenviro.com <br />Please allow 10 business days from date of application submittal for the records to be available. <br />Staff will conto to range a%,,ap/� intment date and time to review the requested records <br />SIGNATURE OF APPLICANT ���817� DATE July 18, 2018 <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 <br />list 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 below, or email to infoasicehd.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 below. <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 $152 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 <br />FILE ADDRESS <br />D <br />HEALTH DEPARTMENT <br />FILES <br />(Specific addresses <br />only, address ranges will not <br />be accepted) <br />EHD USE ONLY <br />® Underground Tank (UST) <br />Street # <br />Street Name <br />city <br />Cleanup Site (LOP) <br />2230 <br />N. Wilson Way <br />Stockton <br />i - M, llk�' <br />r" <br />❑ CONSUNIFR <br />i ®Other Cleanup Site (Non -LOP <br />® Hazardous Waste <br />�$2 <br />N <br />❑ DAiRY <br />0 Tiered Permitted Facility <br />N. Wilson Way <br />Stocl� <br />® Aboveground Tank <br />2232 <br />•r <br />❑ P%AJS <br />® UST (Monitoring I Removal) <br />�I Hazardous Materials <br />3 <br />® Spill / Release Response <br />QATER QUALITY <br />❑ Solid Waste Facility I Vehicle <br />Food Facility <br />ITE MITIGATION <br />Pool / Spa <br />❑ Dairy <br />5 <br />Lard Use Application Sites <br />s <br />[I HOUSING <br />Septic Pumper Truck / <br />Yard I Chemical Toilets <br />Wastewater Treatment: Plant <br />G CUPA <br />Housing Abatement <br />7 <br />ASTI HM I HW <br />E] Motel/Hotel <br />_ <br />CUPA <br />Ej Chicken Ranch / Dog Kennet <br />Medical Waste Facility <br />8 <br />UST <br />Tattoo/Body Piercing <br />p sou. WASH <br />Waste Tire <br />9 <br />Complaint <br />E] ACC07NT NG <br />F1 Other (Please Specify): <br />10 <br />- <br />'BOXED AREA - EHD USE ONLY*** <br />� •- �**�n(( ? ,h t�nt-..:'Me,I lEt.e,r*{ �a� t Y ,n-. t:7�-�. <br />❑ Records provided by Staff -PPR Complete. Staff Name: EHD 4"6 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />