Laserfiche WebLink
SAN Jr NJIN COUNTY ENVIRONMENTAL HEALTH — -PARTMENT <br />SITE MITIt.)p,TION MASTER FILE RECORD INFOK.iATION FORM <br />"MFR"- GREEN FORM <br />DATE 2017-12-04 SHADED AREAS FOR EHD USE <br />OWNER FILE: PARTY INFORMATION: CHECK IF OWNER IS CURRENTLY ON FILE WITH EHD COMPLETE PROPERTY OWNER/ RESPONSIBLE <br />PROPERTY <br />OWNER NAME <br />Bill Filios PHONE <br />(209) 823-3121 FIRST MI LAST <br />BUSINESS NAME <br />AKF Development Holdings LLC <br />E-MAIL ADDRESS akfdev@aol.com <br />OWNER HOME ADDRESS 1463 Moffat Blvd ATTENTION: ORCARE OF (oPTIONAL) <br />CITY Manteca STATE CA ZIP 95336 <br />OWNER MAILING ADDRESS <br />MAILING ADDRESS CITY STATE ZIP <br />L14 CORPORATION I=1 INDIVIDUAL I=1 PARTNERSHIP ill GOVERNMENT AGENCY I=1 RESPONSIBLE PARTY El OTHER <br /> <br />0 ENVIRONMENTAL <br />ASSESSMENT <br />2950 <br />LI EHD LOCAL VOLUNTARY <br />CLEANUP <br />2953 <br />LII RWQCB LEAD — <br />CORRECTIVE ACTION <br />2960/3526/3527 <br />X RWQCB LEAD — <br />WATER QUALITY (WDR) <br />2965 <br />El DTSC LEAD <br />2959 <br />0 FED EPA LEAD <br />2954 <br /> <br />FACILITY FILE: COMPLETE BUSINESS! SITE/ PROJECT INFORMATION: <br />IS THIS A NEW PROJECT LOCATION NOT PREVIOUSLY REGULATED BY THE ENVIRONMENTAL HEALTH DEPARTMENT? <br /> <br />YES El <br />No Igt <br />IS THIS AN EXISTING PROJECT LOCATION, BUT A NEW SCOPE OF WORK? <br /> <br />YES <br /> No El <br /> <br />BUSINESS/FACILITY/SITE/PROJECT NAME Spreckels Closure Investigation APN: 022-125-035 <br /> <br />SITE ADDRESS! PROJECT LOCATION 407 Spreckels Ave BUSINESS PHONE <br />Manteca <br /> STATE CRP 95336 <br />BOARD OF SUPERVISOR DISTRICT LOCATION CODE KEY1 KEY2 <br />MAILING ADDRESS , IF DIFFERENT FROM FACILITY ADDRESS <br />MAILING ADDRESS CITY <br /> STATE ZIP <br />SIC CODE <br /> COMMENT: <br />THIRD PARTY BILLING INFO: COMPLETE IF BILLING PARTY IS DIFFERENT FROM PROPERTY OWNER OR RESPONSIBLE PARTY IDENTIFIED ABOVE. <br />BUSINESS NAME ATTENTION: ORCARE OF (OPI7ONAL) Anthony Wohletz Kleinfelder <br />MAILING ADDRESS 2882 Prospect Park Dr., Suite 200 PHONE (530) 321-1280 <br />CITY STATE Rancho Cordova CA ZIP 95670 <br />IACCOUNT ADDRESS TO SEND FEES AND CHARGES: <br /> <br />OWNERD <br /> <br />FACILITY/BUSINESSO <br /> <br />THIRD PARTY BILLINGS <br />BILLING AND COMPLIANCE ACKNOWLEDGMENT: I, the undersigned Applicant, certify that I am the Owner, Operator, Authorized Agent, <br />or Responsible Party and I acknowledge that all PERMIT FEES, PENALTIES, ENFORCEMENT CHARGES and/or HOURLY CHARGES associated <br />with this project will be billed to me at the address identified above as the ACCOUNT ADDRESS for this site. I also certify that all information <br />provided on this application is true and correct; and that all regulated activities will be performed in accordance with all applicable SAN <br />JOAQUIN COUNTY ORDINANCE CODES and/or STANDARDS and STATE and/or FEDERAL Laws and REGULATIONS. As the undersigned <br />Owner, Operator, Authorized Agent, or Responsible Party for the project located above under facility/site address, I hereby authorize the <br />release of any and all results, reports, and other environmental assessment information to SAN JOAQUIN COUNTY ENVIRONMENTAL <br />HEALTH DEPARTMENT as soon as it is available and at the same time it is provided to me or my representative. <br />APPLICANT NAME (PLEASE PRINT) Anthony Wohletz SIGNATURE <br /> <br />TITLE Staff Geologist <br /> <br />TAX ID # <br /> <br />FA #: Q 6:0.24 31 i OWNER ID itEN Ak ej z2_13-1,7 ACCOUNT #: e_0(34544,71 ASSIGNED TO: <br />PR ft: ?1.2.1) s-422. / j ID ACCOUNTING COMPLETED BY: DATE: /2/ <br />SR TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE SERVICE REQUEST# INVOICE# <br />Work Plan 2903 <br />2904 <br />523 <br />523 <br />$456.00 <br />$760.00 4 11 SIO V7-I'' v--- Pli(ki sit- ooly5-)o <br />Site Mitigation MFR 29- )00< 8-1-2017