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I <br />FEB 10 2015 <br />Telephone: <br />ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES <br />• SAN JOAQUIN COUNTY 0 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />(209) 468-3420 Fax: (209) 464.0138 Web: www.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />EHD LOG NUMBER <br />0379 <br />APPLICANT: Yukari Hirayama BUSINESS/AGENCY: Advanced GeoEnyironnlental <br />ADDRESS: 837 Shaw Road CITYISTATEIZIP: 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 -"Tentative only- must be confirmed) <br />❑ CHECI( BOX TO EXPEDITE RE�QUEST- $125 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN:3 BUSINESS DAYS <br />SIGNATURE n <br />OF APPLICANT L4 DATE 2/10/2015 <br />Electronic Information: ❑ List E] Map — Description: <br />to <br />FIRE ADDRESS <br />EHD USE ONLY <br />Unit1 <br />HOUSING ABATEMENT <br />Street# - Street Name <br />city <br />1 <br />1413 Bourbon Street <br />Stockton <br />kAL,V - <br />2. <br />3755 West Lane <br />Stockton <br />3. <br />3805 West Lane <br />Stockton <br />r D-l1nH 3 <br />4. <br />C <br />-0-Unit 4 <br />6. <br />7. <br />D Unit 6 <br />8. <br />9. <br />N'1 <br />y'l� p nit 6 <br />10. <br />Specific Date Range of Information Requested: From <br />x❑ UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />Z OTHER CLEANUP SITE (NON -LOP) <br />%❑ UNDERGROUND TANK (MONITORINGIREMOVAL) <br />Q HAZARDOUS WASTE GENERATOR <br />Q TIERED PERMITTED FACILITY <br />❑ TATTOOIBODY PIERCING <br />❑ MEDICAL WASTE FACILITY <br />all <br />to <br />PAL HEALTH DEPARTMENT FILES <br />HOUSING ABATEMENT <br />❑X SOLID WASTE FACILFrYNEHICLE <br />FOOD FACILITY <br />El WASTE TIRE <br />DOG KENNEL <br />El DAIRY <br />CHICKEN RANCH <br />❑ WASTEWATER TREATMENT PLANT <br />MOTELIHOTEL - <br />❑ PUMPER TRUCKIYARD(CHEMICALTOILET$ <br />POOLISPA <br />Q LAND USE APPLICATION SITES <br />COMPLAINT RECORDS <br />❑ OTHER (PLEASE SPECIFY) <br />WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:0o AM-5:OOPM (EKCLUDING 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(ee). At least one file type MUST be selected. Fax to (208) 464.0138 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 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 />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 some 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 />Rece-ived Time Feb. 10. 2015 11:45AM No. 8087 <br />�a <br />n, <br />