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9aEic 18 15 03:33p Nelson Environmental 775-254-3748 p.1 <br /> IN III <br /> to <br /> o Is <br /> DATE RECEIVED �-"� I EHD LOG NUMBER <br /> - SAN JOAQUIN COUNTY <br /> • ,EC G 1. 2015 ENVIRONMENTAL HEALTH DEPARTMENT �;Dq7 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> F(-'%+ndNP,4Et,[TALHEAL�lephone: (209) 468-3420 Fax: (209) 4e4-0138 Web: www.sjgov.org/ehd <br /> PERT 0T,reE9*0CES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:Mike Nelson BUSINESS/AGENCY: Nelson Environmental <br /> ADDRESS: 103 Laurel Ave. CITYISTATEIZIP:Atwater, CA 95301 <br /> PHONE(1). 209-769-7460 PHONE (2): FAXORE-MAIL: mike@nelsonenviro . <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 BOX TO EXPEDITE REQUEST-- 1130,FE (CASH OR ECK_ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT / 1/ DATE 12/18/15 <br /> Electronic Information: ❑ List ❑ Map—Description: i <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> 816 Frontage Rd. Ripon <br /> ❑ Unit <br /> 2� <br /> 3. ❑Unit 2 <br /> q. ❑ Unit 2H <br /> 5 1;1 Ini[3 <br /> 6 []'Unit 3HM <br /> 7. 12;6n'it 4 <br /> 8 EPSITE MITIGATION <br /> 9. ❑Unit 5 <br /> 10. <br /> SpecifK Date Range of Informatiaa Reglested: Fmm to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I?3 UNDERGROUND TANK(UST)CLEANUP SrrE(LOP) ❑MOTELIHOTEL ❑SOLID WASTE FACILT YIVEHICLE <br /> ©OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑FOOD FACILITY <br /> ©UNDERGROUND TANK(MONITORINGIREMOVAL) ❑WASTE TIRE ❑DAIRY,PODUSPA <br /> Q ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATERTREATMENT PLANT <br /> ®HAZARDOUS WASTE ❑MEDICAL WASTE FACILITY ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> HAZARDOUS MATERIALS ❑TATTOO/BODY PIERCING ❑LAND USE APPLICATION SITES <br /> ❑TIERED PERMITTED FACILITY ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLANDSEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW' MONDAY-FRIDAY 8'00AM-5:00PM(ExcUuDING 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 /> —"SOXED AREA-EHD USE ONLY" <br /> 71 <br /> ❑ Records provided by Staff-PPR Complete. Start Name: <br /> Received Time=Dec. 18. -2015= 3: 19HF`No. 0226 <br />