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,om <br /> I Q <br /> EHD LOG NUMBER <br /> �tsQ SAN JOAQUIN COUNTY <br /> l� ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEB 0 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd 0 <br /> ENVIRONMENTAL HEALTH <br /> PERMITISERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Yukari Hirayama BUSINESS/AGENCY:Advanced GeoEnvironmental <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 buslnass days from data of application submittal-*Tentative 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 APPLICANT DATE 2/10/2015 <br /> Electronlo Information: ❑ List❑ Map—Descrlptlgn: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city UnR1 <br /> 1• 1413 Bourbon Street Stockton <br /> 2. 3755 West Lane Stockton ,-unit2 <br /> 3. 3805 West Lane Stockton <br /> 4. t11 E Unita <br /> 6, <br /> s• -E-CI 4 <br /> 7. 'Wrl�l (Zf�(ec, wnd 1GQ' <br /> s. 171 <br /> Unit s <br /> Specific Data Range of Information Requested: From all to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> El UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ©SOLID WASTE FACILHYNEHICLE <br /> I]OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY O WASTE TIRE <br /> E UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑x DAIRY <br /> x j HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> X❑TIERED PERMITTED FACILnY ❑MOTELIHOTEL ❑PUMPERTRUCIWARD/CHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOL/SPA Q LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY El COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Seleetthe 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(2081464.0138 or mail to the address Indicated above. Address <br /> ranges will not be accepted-foradditional 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 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 /> N-,4 t q r ai a71c,,A COtAi30477 10WOG %-AA , <br /> aNt.jiej U t. tAtiT `Ijr fy i Iq 112 NqAAj3 West n. <br /> a"111 <br /> Received Time Feb. 10. 2015 11 :45AM No. 8087 <br />