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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> SITE MITIGATION MASTER FILE RECORD INFORMATION FORM <br /> "MFR"-GREEN FORM <br /> DATE 6/17/2016 SHADED AREAS FOR EHD USE <br /> OWNER FILE:COMPLETE PROPERTY OWNER/RESPONSIBLE PARTY INFORMATION: cREcrsoKrvEawcaiaeEA'nraysueNrrx END® <br /> PROPERTY PHONE <br /> OWNEAMAME ToRsr M, I ST 980.474-3643 <br /> BuaNEes NAME SPX Corporation I <br /> 041a ORE <br /> wa ler. es alacki s x.com <br /> OWNER HI RIE ADDRESS ATTENTION:oRO&RE OF(CFTAMNL) <br /> CM <br /> STAT! 2P <br /> OWNERMAXAWADORESS 13320-A Ballantyne Corporate Place <br /> M"R'1O"00RE°°Orry Charlotte aT"TE NC 'OP 28277 I� <br /> ®CORPORATpN ❑INomNML ❑PARTNeasur ❑OOVE/NMENT ADENcr ❑RESPONSIBLE PARTY ❑OTHER <br /> ❑ ENVIRONMENTAL ❑ Eli D LOCa-VOLUNTARY ❑ RWQCB LEAD— ❑ RWQCB LEAD— rI��II DTSC L�FEo <br /> ASSESSMENT CLEANUP CORRECTIVE ACTON WATER QUALITY(WDRj W 2959 <br /> 2950 2953 2960/352613527 2965 <br /> FACILITY FILE:COMPLETE BUSINESS ISITEI PROJECT INFORMATION: <br /> IS THIS A NEW PROJECT LOCATION N91 PREVIOUSLY REGULATED BY THE ENVIRONMENTAL HEALTH DEPARTMENT? YES ❑ No [2 <br /> IS THIS AN EJSanNG PROJEOT LOCATION,BUT A NEW SCOPE OF WORK? YES ® No ❑ <br /> BUSNEaWAOUTV18REMRWEOTNAMe SPX Marley Cooling Facility I <br /> 143-310-07 <br /> SrrEADOREasIPRaEmLooAmN 200 N Wagner Avenue BUSINESS PHONE 209-337-8278 <br /> cm Stockton STATE CA ZP 95725 <br /> BOARDOF BUPERVMOR DISrnIDT LOCATION CODE KEYt KEY2 <br /> MAa Ro ADNIEaa.■DIFiERENTERoRFACLm ADDREEB <br /> MAarNo ADWNCm STATE by <br /> SICCODE OOMMEM: <br /> THIRD PARTY BILLING INFO:COMPLETE IF BILLING PARTY IS DIFFERENT FROM PROPERTY OWNER OR RESPONSIBLE PARTY IDENTIFIED ABOVE. <br /> BUINE"NATE AITENrgN:glCARE OF(OPrRWU) <br /> MAEAND ADoREM PHONE <br /> Cm STATE ZIP <br /> ACCOUMADDIIFEa TO SEND FFIDANDOHIIROFA: OWNE FACILITYIBUSINE IR THIRD PARTY BILLING❑ <br /> BILLING AND COMPLIANCE ACKNOWLEDGMENT: I,the undersigned Applicant,certify thartam the Owner,Operator,Authorized Agent, <br /> or Responsible Party and I acknowledge that all PERMIT FEES,PENALT/ES,ENFORCEMENT CHARGES and/or HOURLY CHARGES associated <br /> with this project will be billed to me at the address identified above as the ACCOUNTADDRESs 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 /> APPucANY NAME(PLEASE PRINT) �cJ l-'Q�le'T� SAf:J� SENATURe <br /> TITLE 7 TAXIDti <br /> /T71 rt, Y1A V.✓ <br /> FAS: o"EA SOM ACCOUNTI: AaaENEDTO: <br /> no: / /D ACCOUNTINOCOMPLEIEDBY: <br /> 9-3-2015 <br /> Site Mitigation MFR 29- <br />