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SA N tJ OA QU <br /> 9nvironmental Health Department <br /> COUNTY �,t�L � PUBLIC RECORDS RELEASE APPLICATION <br /> `'EN1/IRANMENTAL!MTH (Z" d <br /> • r?EWT/5nIF4; EHD LOG NUMBER: <br /> APPLICANT: Mike Nelson BUSINESS/AGENCY: Nelson Enviro, LLC <br /> ADDRESS: 103 Laurel Ave. CITY/STATE/ZIP: 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 cont o to range a ap intment date and time to review the requested records. 2018 <br /> SIGNATURE OF APPLICANT I�11561,14 �Iji DATE JUIy 18, <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 infolaDsicehd.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. 1- <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 /> HEALTH DEPARTMENT FILE ADDRESS _ t] Z3 ��' <br /> J FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> KI Underground Tank(UST) Street# Street Name city <br /> Cleanup Site(LOP) f M w ❑CONSUMER <br /> i ®Other Cleanup Site(Non-LOP <br /> f 2230 N. Wilson Way Stockton _ <br /> • ®Hazardous Waste <br /> ry� ❑DAIRY <br /> []Tiered Permitted Facility z 2232 N. Wilson Way �+tOC <br /> ®Aboveground Tank J • <br /> ®UST (Monitoring/Removal) i ❑PWS <br /> Hazardous Materials s <br /> i <br /> ®Spill/Release Response <br /> ©'VVATER QUALITY <br /> Solid Waste Facility I Vehicle 4 <br /> Food Facility <br /> EJ Pool/Spa <br /> t ITE MMGATION <br /> ❑Dairy b <br /> F1 Lard Use Application Sites <br /> Septic Pumper Truck/ 6 ❑HOUSING <br /> Yard!Chemical Toilets <br /> �Wastewater TreatmenL Plant p CUPA <br /> Housing Abatement 7 ASTI HM I HW <br /> I <br /> E]Motel/Hotel 4 <br /> El Chicken Ranch/Dog Kennel CUPA <br /> Medical Waste Facility 8 UST <br /> Tattoo/Body Piercing ❑Souo WASTE <br /> Waste Tire g <br /> Complaint <br /> Other(Please Specify): ❑Acco:lNnuG <br /> 10 <br /> 'BOXED AREA-EHD USE ONLY' <br /> • 23 X— cm <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: EHD 48-06 <br /> 1868 E. Hazelton Avenue 1 Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sjcehd.Com <br />