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"1181503:33p Nelson Environmental 775-254-3748 p.1 <br /> i■ <br /> me <br /> RECEI'VE�O t_ EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> inc 21 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ;Dq7 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Mike Nelson BUSINESSIAGENCY: Nelsen Environmental <br /> ADDRESS: 103 Laurel Ave. CITYISTATE(ZIP: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 contactyou to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST- 130 FE (CA,SH OR ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /C�� DATE 12/18/15 <br /> Electronic Information: ❑ List ❑ Map—Description: 1 <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name City <br /> 1. 816 Frortage Rd. Ripon [.,op-clo <br /> ❑ unit' <br /> _2.—� <br /> 3• C-6 ❑Unit <br /> '4• �L..,^ E3 Unit 2H <br /> 5. 4 <br /> ��""nic 3 <br /> 1*20 5. []'Unit 3HM <br /> 7. 9 unit4 <br /> 8. DyirrE MITIGATION <br /> 9. <br /> 10. ❑ Unit 5 <br /> Specific Date Range of Infmmatian Requested: From B <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTELIHOTEL ❑SOLID WASTE FACILITYIVEHICLE <br /> XJ OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑FOOD FACILITY <br /> ©UNDERGROUND TANK(MONITORING/REMOVAL) ❑WASTE TIRE ❑DAIRY,PDDLISPA <br /> Q ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ®HAZARDOUS WASTE ❑MEDICAL WASTE FACILITY ❑PUMPER TRUCKIYARDICHEMIOAL TOILETS <br /> Pq HAZARDOUS MATERIALS ❑TATTDOIBODY PIERCING ❑LAND USE APPLICATION SITES <br /> ❑TIERED PERMITTED FACILITY ❑COMPLAINVRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> _ WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REYIEw: MONDAY-FRTDAY8:OOAM•5:00PM(EXCWOiJG 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)4640138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:DD pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD atthe 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 vAll be reorganized by EHD staff at the expense of the applicant <br /> Futurefile reviews by the same applicant may require a$130 deposit prior to review. <br /> "'BOXED AREA-EHD USE ONLY`"` <br /> CJti e fill$ VIA C <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> Received Time=Dec. 18. =2015= 3: 19PNrNo 0226 <br />