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Fnviro Health Page 1 of 1 2017-01-13 00:24:08 (GMT) From: Mike Nelson <br /> mills <br /> ■ ■ GIVER[ SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ■ <br /> ONEENVIRONMENTAL HEALTH DEPARTMENT <br /> JAN 1 3 2017 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: vvww.sjgov.org/ehd <br /> E'1WIRONf�EF1�fiAL Ft!~•'k1.TH <br /> PEl11MfT18Eh'afft..E31 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Mike Nelson BUSINESS/AGENCY: Nelson Enviro LLC <br /> ADDRESS: 103 Laurel Ave. CITY/STATE21P:Atwater, CA 95301 <br /> PHONE (1): 209-769-7460 PHONE (2): FAXORE-MAIL: mike@nelsonenvirc . <br /> Please allow 10 business days from date of application submittal for the records to be available, com <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> CHECK BORTt3 (pE1TE REt3(� �`�K)1"'rSl",(�rJJEi{ 'g'"' 1,©R CHECK(�N�:'y REgllS�3;.1 {35$ D iN6US;i17ESS qA'£S <br /> SIGNATURE OF APPLICANT N¢�B� DATE 1/12/2016 <br /> Electronic Information: ❑ List ❑ Map- Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name City <br /> 1' 1399Manteca <br /> 2 Main ❑Unit 1 1�2y <br /> 3. Rf <br /> Unit 2 <br /> 4. <br /> (D , ❑Unit 2H <br /> 5. <br /> m Unit 3 <br /> • e unitsT <br /> 7 -1'7'1 <br /> ❑Unit 4 <br /> 8, <br /> SITEMITIGATION <br /> 9. <br /> 10. ❑Unit 5 <br /> Specific Date Range of Information Requested: From to <br /> Et+k)tiR.Ot!)tl'AENT{U:,,HEALTH DEPAR�7;iiA�JdT.F1E:)=S <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTELIHOTEL ❑SOLID WASTE FACILITYNEHICLE <br /> 7C❑OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑FOOD FACILITY <br /> Q UNDERGROUND TANK(MONrrORING/REMOVAL) ❑WASTE TIRE ❑DAIRY,POOLISPA <br /> X❑ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ®HAZARDOUS WASTE ❑MEDICAL WASTE FACILITY ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ®HAZARDOUS MATERIALS ❑TATTOOIBODY PIERCING ❑LAND USE APPLICATION SITES <br /> ❑TIERED PERMITTED FACILITY ❑COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLEFOR REVIEW: MONDAY-FRIDAY 8:00 AMWELLAND SEPTIC PERMIT RECORDS ARE REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS)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$130 deposit prior to review. <br /> ***BOXEDAREA-EHD USE ONLY*** <br /> 0 Records provided by Staff-PPR Complete. Staff Name: <br /> Received Time Jan. 12. 2017 4: 19P No. 0682 <br />