Laserfiche WebLink
0 0 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> DATE MASTER FILE RECORD INFORMATION ((MFR" GREEN FORM <br /> 1 __._._._._..__.._. _.. _. SITE MITIGATION & LOP <br /> BHA E.kEO�FMR-USE QalY OWNER IDE CAse# UNIT IV tl <br /> OWNER FILE:COMPLETE PROPERTY OWNER/RESPONSIBLE PARTY INFORMATION: ONeD#R'OInymar CuRRENrL r ON rue w,,H EHD <br /> PROPERTYOwMERNAME Ron Browne 800) 501.5589 <br /> FIR$T MI LAST PHONENUMBER . <br /> Busommis NAMe W.A.R.Z.Stockton,LLC f-MAILADDRESB <br /> OWNER HOME ADDRESS <br /> Cm STATE LP <br /> OMMMA1LINGADnREBh 24025.Callfornia Street <br /> Muuxo AopaEeeOm Stockton STATE CA ZIP 95206 <br /> ❑CORPORATION ❑INDMIDUAL ❑PARTNER#HIP ❑GOVERNMENT AGENCY RESPONSIBLE PARTY ❑OTHER <br /> SITEMITIGATION ENVIRONMENTAL ASSESSMENT-A_VOLUNTARY CLEANUP_WATER QUALITY...... HW PIPELINE INVESTIGATION_ LOP <br /> FACILITY ID IF INV# ACCOUNT ID PR#IRO# ASSIGNED EMPLOYEE Lease AGENCY-.EHD_RWQCB_DTSC_EPA <br /> _ <br /> (FACILITY FILE:COMPLETE BUSINESS/SITE/PROJECT INFORMATION: <br /> IS THIS A NEW PROJECT LOCATION NOT PREVIOUSLY REGULATED BY THE ENVIRONMENTAL HEALTH DEPARTMENT? YES ❑ No <br /> IS THIS AN EXISTING PROJECT LOCATION,BUT ANEW SCOPE OFWORK? YES ® No ❑ <br /> BUSINESBIFACILRY/STE)PROUECTNAME White Arrow <br /> SOEAnorame/PRosEorrLOCATKmN SUrTE# BUSINESS PHONE <br /> 2402 5,California Street (800)501-5589 <br /> CITY Stockton STATE CA ZIP 95206 <br /> BOARD OF SUPERVISOR DISTRICT LmAT*m CODE KEY1 KEY2 <br /> MAILING Anoness,IF DIFFERENT FROM FACW"AUDRESS ATTENTION:ORCARE OF(OPTIONAL) <br /> MAILING ADDRESS CITY STATE LP <br /> SIC CODE APN# COMMENT: <br /> THIRD PARTY BILLING INFO:COMPLETE IF BILLING PARTY IS DIFFERENT FROM PROPERTY OWNER OR RESPONSIBLE PARTY IDENTIFIED ABOVE. <br /> BUSINESSNAME P1,100r Engunceringand Science.Inc. ATTENTION:ORCARE OF (bionVaGI)Samantha Harris <br /> MAILING ADDRESS PHONE <br /> 2154 Totrenee Boulevard.Suite 200 310-6154500 <br /> CITY 'I OITAIICC STATE ZIP 90501 <br /> ('A <br /> ACCOUNTADDREBs TO SEND FEES AND CHARGES: OWNER FAca.ITYBUSINESSO THIRD PARTY BILLING® <br /> BILLING AID C•G>IVLL\K('Y.ACFFOP LEDrninst.: I.the Andersh Nd Applitam,fCl'tifc that 1 am He Oumr,ORemnrr,.Lnlmrired dgn...lir Responsible Para and I aek ..ledge that all PERUf1 FEES. <br /> P!\{mEF.E\FOR('cim,ITC,4wR 5 And/Or 110(ft,(11lRGA5 aswuled pith NITS projert Nill be Mlled t0 nM at the address Wattled a6%'e 15 the R I NTASIAl.'SR for MLS site. 1 i len cerKO that All <br /> inlornwtkm prodded ml this appiicution Ir Irne and cnrnel:Sad thm All regulmM.010fies out be perfnrmetl In areurdanee aIII it appl@nble S\1.15L\9rlY On vn (hum\srk('Onk:S unNor <br /> Sr.\sD.UtDti and STere nnNor FPDI•R4L,lave and ItEfea.At ItS+s. As the UnJrni;;md Oavrr,Ofxrarnr,:Wr/mriuA9,GrrA.ar Reylmniblr Panr far IM`prpiert IPcaecd nWve Ander drilihlsile addnss.I <br /> hereby natl5abe OH rNease of any Slid all resales,repents,and oda`r e.,rirCarole aAI asscumenr hlfornmtalt to Sas JO.A(HIN COlarl11A-bals]IENTAL Ilk n lap Dh.PAIG>1E\T as soon as i 'x aeatlable <br /> and al the same time it is pre,Ided tome or nn rcpreR•ntathr. <br /> APPLICANT NAME(PLEASE PRINT) Samantha Harris SENATOR <br /> TITLE Senior Project Manager TAK # _+43?Y <br /> APPRovion BY DATE ACCWHnNGOFPCEPROCESBINOCOMPIEIEOBY DATE <br /> SITE MITIGATION AMOUNT PAID DATE DP PAYMENT PAYMENTTYPE RECEIPT# CHECK# RECEIVED BY WORK PLAN P]E <br /> FEE!$ <br />