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3500 - Local Oversight Program
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PR0544465
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Last modified
5/16/2019 11:54:59 AM
Creation date
5/16/2019 11:30:23 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
WORK PLANS
RECORD_ID
PR0544465
PE
3528
FACILITY_ID
FA0005837
FACILITY_NAME
STEFANOS GASOLINE*
STREET_NUMBER
1419
Direction
E
STREET_NAME
CHARTER
STREET_TYPE
WAY
City
STOCKTON
Zip
95205
APN
15137016
CURRENT_STATUS
02
SITE_LOCATION
1419 E CHARTER WAY
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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is%. .Services, <br /> Wright <br /> EnvironmentalLE <br /> Inc. Ed,µ T <br /> Construction ♦ Engineering ♦ Remediation <br /> Authorization To Access Property, <br /> Obtain Permits and Perform Work <br /> Effective Date: 7~ X°t- 03 <br /> (Please print required information on blank lines, and sign and date below.) <br /> I, A P 'PA" 14�-- , property owner/trustee of .f 3 3 3 _ CN R R TE-1L Loy. <br /> (name) (work site address) <br /> STAG, IF 5-02°S hereby authorize Wright Environmental <br /> (city) (Zip) <br /> Services, Inc., and/or it's subcontractors, to obtain required permits, and access my <br /> property at "work site address"for purposes of performing all, or part of, the "scope of <br /> work" below as required by SAN aToAQ`"^' CovAATY amp+• <br /> (Govt. Agency.Regbiring Said Work) <br /> Wright shall leave.property in as clean a condition, as it was upon access to property. This <br /> authorization shall-be effective for a period of one (1)-year from the "effective-date" of this <br /> authorization to cover the time.period for inspections, lab analysis and for future access to <br /> perform on-going tasks such as additional testing, surveying, quarterly monitoring,,etc. <br /> SCOPE OF WORK: <br /> Coring, boring, drilling, cone penetrometer boring, aquiring soil and/or water samples, <br /> installing various wells, monitoring, testing, surveying, and/or other tasks as may be <br /> required. <br /> ! To: S 71D c V-To N /�'01`a fz Z�IVN <br /> Signed: <br /> (Property Owner) <br /> l <br /> 1333 r_ CNh <br /> Date. % :; , C' 5T c64T-o / CR <br /> 9S"a o S <br /> 67—Z. 10th tree: •► Trac;✓;C.� Q;,76 <br /> 209.833.0758 , Fax 209.832.5152 <br /> wright(winreach.com Lic. #651 01 d-B Hazifat 4M <br /> websit http://home.inreach.comlwright <br />
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