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FIL v 4 D LOG NUMBE <br /> .f bAT R{CEIVEL���E SAN JOAQUIN COUNTY EH R <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ' JUN 0 `t X15 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:Yukari Hirayama BUSINESS/AGENCY:Advanced GeoEnvironmental, Inc. <br /> ADDRESS: 837 Shaw road CITY/STATE/ZIP:Stockton/CA/95215 <br /> PHONE(1): 209-467-1006 PHONE(2):818-486-2160 FACSIMILE:209-467-1118 <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment.date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT v DATE 09 June 2015 <br /> Electronic Information: ❑ List OYAap—Description: <br /> FILE ADDRESS END USE ONLY <br /> Street# Street Name 75tockt7on <br /> El Onit 1 <br /> Z. 1404 South Fresno Avenue <br /> 2. 1405 South Fresno Avenue �(�' octon •1f 1It 2 <br /> 3. 1524 South Fresno Avenue Stockton <br /> 4. 1815 Navy Drive Stockton (i�5 ��` unit 3 <br /> 5. 1541 West Charter Way Stockton <br /> SITE MtTI0ATI0N / <br /> 6. ,'Unit 4 <br /> 7. <br /> 8. ❑Unit 5 <br /> 10. dtlnit 6 <br /> Specific Data Range of Information Requested: From All to ` <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑■ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑■ SOLID WASTE FACIUTYNEHICLE JVO CA4 <br /> Q OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT FEW WASTE TIRE <br /> ©UNDERGROUND TANK(MONITORINGIREMOVAL) []FOOD FACILITY 0 DAIRY <br /> Q ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ©HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARDFCHEMICALTOILETS <br /> FRI TIERED PERMITTED FACILITY ❑POOLISPA ❑■ LAND USE APPLICATION SITES <br /> ❑TATTOo/BODY PIERCING COMPLAINTIRESPONSE RE=CORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND 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. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(208)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. Kor 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 ton(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$125 deposit prior to review. '*BOXED AREA-EHD USE ONLY"" <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> CUMAa n� 5/11!15 <br /> Received Time Jun. 9. 2015 9:27AM No. 8920 <br />