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c 11 1506:50a Nelson Environmental 775-254-3748 p.1 <br /> ■ <br /> s ■ <br /> ■ <br /> '■■ DATE RECEIVED ( � ` ' ,� •'�� "„^LOG NUMBER <br /> ' ' ' 'f tEDD SAN JOAQUIN COUNTY <br /> ■ 'tiv <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> • CLEC 1 1 20153 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> ENVIRONMENTALkE^-.LT(a <br /> rr,I ;e�R1 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Mike Nelson BUSINESS/AGENCY: Nelson Environmental <br /> ADDRESS: 103 Laurel Ave. CITYISTATE/ZIP: Atwater, CA 95301 <br /> PHONE(1): 209-769-7460 PHONE (2):mike(EDnelsonenyino.COnSACSIMILE:775-254-3748 <br /> Please allow 10 business days from date of application submittal For the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ®CHECK BOX TO EXPEDITE REQUF`E 12 E(CASH R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSiNES7 DAYS <br /> SIGNATURE OF APPLICANT .% '� d> L, DATE Z <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street* Street Name city - ❑Unit 1 <br /> 1. 520 Carolyn Weston Blvd. Stockton <br /> 2. 3526 Manthey Rd. Stockton <br /> p unit <br /> 3, 3408 Manthey Rd. Stockton <br /> 4. O'Unit 3 1'71 mou <br /> 5. <br /> s. ,nit 4 <br /> 7. <br /> B. <br /> ❑ Unit 5 <br /> 9. 0A, <br /> 16. <br /> Specific Date Range of Information Requested: From to <br /> rr�y� ENVIRONMENTAL HEALTHDEPARTMENT FILES <br /> yJ UNDERGROUND 7ANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILTIYIVEWCLE <br /> ®OTHERCLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ®UNDERGROUND7ANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ®ABOVEGROUND7ANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ®HAZARDOUS WASTENAZARDOUSMATERIALS ❑MOTEL(HOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOIISPA ❑LAND USE APPLICATION SITES <br /> ❑TAT7001BODY PIERCING ❑CDMPLAINTRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:DO AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of foes from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)4r>4-0138!>r 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 riles exist. An appointment for review will be confirmed approximately ten(10) <br /> days after recelpt 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 /> tRecords provided by Staff-PPR Complete. staff Name: <br /> EHD 4e-0e 412V14 <br /> Received Time Dec. 11, 2015 6: 35AM No, 0168 <br />