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rEHD LOG NUMBER <br /> a � SAN JOAQUIN COUNTY 0 <br /> � M ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEBd 2015 1868 East Hazelton Avenue, Stockton,CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 484-0138 Web:www.sjgov.orglehd k <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Yukari Hirayama BUSINESSIACENCY:Advanced GeoEnviron mental <br /> ADDRESS: 837 Shaw Road cITY/srATE/zIP: Stockton/CA/95215 <br /> PHONE(1): 818-486-2150 PHONE(2):209-623-7200 FACSIMILE: 209-467-1118 <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from data of application submittal-•Tdatefive only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF AFFLICANT DATE 2/10/2015 <br /> Electron lo information: ❑ Llst❑ Map—DeserlptlQt1: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit1 <br /> 1• 1413 Bourbon Street Stockton '^`'1 -`O / <br /> 2. 3755 West Lane Stockton <br /> 3. 3805 West Lane Stockton A <br /> 4. rv2 EaFUnit a <br /> 6. <br /> 6. -B-Un�lt 4 <br /> 7. P�1�i�ea iat�y ,�a1(o <br /> 8• FIUnit 5 <br /> punit 6 <br /> Specific Data Range of Information Requested: From all to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> x❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 0 SOLID WASTE FACILITYIVEHICLE <br /> x❑OTHER CLEANUP SITE(NON•LOP) ❑FOOD FACILITY (]WASTETIRE <br /> X❑UNDERGROUND TANK(MONITORING/REMOVAL) E]DOG KENNELx❑PAIRY <br /> X❑HATAROOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> XI TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPERTRUCKIYARD/CHEMICAL TOILETS <br /> ©TATroOIBODY PIERCING ❑POOL/SPA Q LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY COMPLAwTRECOROS ❑OTHER(PLEASESPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS AREAVAILASLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-8:00PM(EXCLUDING 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(208)464.0136 or mall to the address indicated above, Address <br /> ranges will not be accepted-for additional assistance with file addresses, contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant If any EHD files exist. An appointment for review will he 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 /> 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A new application may be <br /> submitted when the file is available. <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. <br /> nf,1AeJ ca 't5 0 e f ate` ' , �7� for NOS yAk In. <br /> 4dev1 Uj + iI UtiT tie / I ria t 5k ✓ 3 5S Web4 L.q. <br /> Rec'e'ived Time Feb. 10. 2015 11 :45AM No. 8087 a„n, <br />