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4 <br /> t <br /> \ t <br /> ❑ New Facility ❑ Existing Facility <br /> San Joaquin County Environmental Health Department <br /> Application___Form <br /> Facility Name <br /> Bobson Cleaners, Inc. <br /> Site Address 600 N Main St City Manteca State California ZIP 95336 <br /> APN 223-141-17 Supervisor District <br /> Type of Service ❑Application for onsultation ❑Change of Owner ❑Repairs or Remodel 113 Other <br /> Requested Operating Permit <br /> Comments <br /> Destruction of 7 soil vapor wells <br /> If mobile food truck or License Plate Number VI N <br /> pumper truck <br /> Contact Types 1A Billing Party ❑Facility Owner ❑Facility Contact X Property Owner f(]Contractor ❑Architect <br /> required <br /> X Billing Party ❑Facility Owner ❑Facility Contact ❑Property Owner ❑Contractor ❑Architect <br /> First Name Paul Last name Sugimoto If contractor,indicate type and license number <br /> Address 2020 L Street, Suite 300 city Sacramento State California ZIP 95811 <br /> Phone Phone Email <br /> (805) 297-0637 paul.sugimoto@aecom.com <br /> ❑Billing Party ❑Facility Owner ❑Facility Contact DA Property Owner ❑Contractor ❑Architect <br /> First Name I nd ra Last name Yadav If contractor,indicate type and license number <br /> Address 3462 Rutherford Drive city Stockton State California ZIP 95212 <br /> Phone Phone Email <br /> (209) 649-3440 info@hwiagency.com <br /> ❑Billing Party ❑Facility Owner ❑Facility Contact ❑Property Owner ®Contractor ❑Architect <br /> First Name Last name Green If contractor,indicate type and license number <br /> Xavier C-57 906899 <br /> Address 220 N. East Street city Woodland State California ZIP 95776 <br /> Phone Phone Email <br /> 530 661-3600 xavier@penecore.com <br /> BILLING ACKNOWLEDGEMENT:I,the undersigned property or business owner,operator or authorized agent of same,acknowledge that all site and/or project <br /> specific ENVIRONMENTAL HEALTH DEPARTMENT hourly charges associated with this project or activity will be billed to me or my business as identified on this <br /> form. <br /> I also certify that I have prepared this application and that the work to be performed will be done in accordance with all SAN JOAQUIN COUNTY Ordinance Codes, <br /> Standards,STATE and FEDERAL laws. /J� 0 <br /> APPLICANT'S SIGNATURE: Pa-L DATE: 11/25/2025 <br /> ❑PROPERTY/BUSINESS OWNER ❑OPERATOR/MANAGER ®OTHER AUTHORIZED AGENT Environmental Engineer/AECOM <br /> Title <br /> If APPLICANT is not the BILLING PARTY,proof of authorization to sign is required <br /> AUTHORIZATION TO RELEASE INFORMATION:When applicable,I,the owner or operator of the property located at the above site address,hereby authorize the <br /> release of any and all results,geotechnical data and/or environmental/site assessment information to the SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH <br /> DEPARTMENT as soon as it is available and at the same time it is provided to me or my representative. <br /> Accepted Assigned T Linked FA ID <br /> — lll,A--,A co)- <br /> Date Fee Record Number <br /> S R 9t5 1 95 <br /> ❑Cash ❑Check# Wconfirmation# // `� Payment <br /> U�i t �v Received By <br /> Rev 07/10/2024 <br />