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SITE INFORMATION AND CORRESPONDENCE
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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BENJAMIN HOLT
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3011
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2900 - Site Mitigation Program
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PR0530063
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
2/6/2019 3:55:34 PM
Creation date
2/6/2019 3:42:59 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0530063
PE
2957
FACILITY_ID
FA0019769
FACILITY_NAME
FORMER SHELL GAS STATION
STREET_NUMBER
3011
Direction
W
STREET_NAME
BENJAMIN HOLT
STREET_TYPE
DR
City
STOCKTON
Zip
95219
APN
10018010
CURRENT_STATUS
01
SITE_LOCATION
3011 W BENJAMIN HOLT DR
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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* 0 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> LOCAL OVERSIGHT PROGRAM <br /> Responsible Party Information as of 6/15/2005 <br /> LOP SITE FILE INFORMATION -- <br /> Locnl Ann�enc Lyse O_p�ly <br /> Case# 1883 Remedial oversight R00000486 <br /> Record ID <br /> Site Name SHELL SERVICE 204-7524-4 Site Record ID SD0000486 <br /> Location 3011 W BENJAMIN HOLT DR Facility Record ID EA0002111 <br /> STOCKTON,CA 95207 <br /> Current Site Business BEN HOLT SHEL L <br /> Phone 209-477-1703 �,`.i's <br /> APN 100-0 1701 � ``- -n- <•_� <br /> The following information is currently on file with this Department. The Primary Responsible Party <br /> identified below will be responsible for payment of invoices for direct oversight charges associated with this <br /> site. If this billing information is not accurate, please make necessary chances in the space provided,date, <br /> sign and return this form. <br /> Make changeslcorrections in RED ink or pencil. <br /> RESPONSIBLE PARTY INFORMATION <br /> RP INFORMATION CHANGE(date) <br /> PRI RP has been named a Primary RP. <br /> Business Name SHELL OIL PRODUCTS US <br /> Contact DENIS L BROWN <br /> Address 20945 S WILMINGTON AVE <br /> CARSON,CA 90810-1039 <br /> Phone <br /> BILLING and COMPLIANCE ACKNOWhourlyLEDGEMENT: I,the undersiwith thisgnesited owner,operator,primary responsidentifiedible party,or agePRIMAYnt of same,acknowPARTY <br /> ledge that all <br /> wil <br /> billed <br /> fsite,orma nd/or project specific,I also certify that all operaattions will erperformed associatedchages accordance with alll applicable theparty <br /> Codes and/or S ands ds and SatteNBLE anld/or Federal Lawsis <br /> TITLE: <br /> PRINTED NAME: <br /> REPRESENTING: <br /> Date <br /> SIGNATURE: <br /> Date 6/15/2005 <br /> Report#8021 <br />
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