My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
SITE INFORMATION AND CORRESPONDENCE
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
C
>
CHEROKEE
>
5279
>
2900 - Site Mitigation Program
>
PR0515087
>
SITE INFORMATION AND CORRESPONDENCE
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
5/28/2019 4:49:35 PM
Creation date
5/28/2019 4:45:54 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0515087
PE
2950
FACILITY_ID
FA0012040
FACILITY_NAME
MORENO TRUST
STREET_NUMBER
5279
Direction
E
STREET_NAME
CHEROKEE
STREET_TYPE
RD
City
STOCKTON
Zip
95215
APN
08705305
CURRENT_STATUS
01
SITE_LOCATION
5279 E CHEROKEE RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\wng
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
6
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> SITE MITIGATION MASTERFILE RECORD FORM <br /> GENERAL PROGRAM FILE: New Change Edit (PROG4) revised 5/23/94 <br /> FACILITY ID # O/ZO T V FACILITY NAME N/1 SMO T�u � <br /> RECORD ID # /J H O Q PRIOR DIST # PRIOR SWEEPS # <br /> /�✓ V 5 z � <br /> C"- E - 0'�'e�ku VZ- . S Ylc� <br /> Site Mitigation: vircnmental Assessment ST/CAP al Hazardous Waste Invest azMat Pipeline Invest <br /> idL <br /> Other Lead Agency Site ency: WQCB DTSC EPA L Site atez Quality Site I IDther Type Site <br /> DESIGNATED EMPLOYEE # 'L I I PROGRAM ELEMENT # � CURRENT STATUS <br /> NUMBER OF UNITS EPA ID #: INSPECTION CODE <br /> Number of TANKS linked to this PROGRAM record <br /> BILLING ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site and/or project specific <br /> PHS-EHD hourly charges associated with this facility or activity will be billed to the party identified as the BILLING PARTY on <br /> the Masterfile Record Information Form. <br /> I also certify that I have prepared this application and that the work to be performed will be done in accordance with all SAN <br /> JOAQUIN COUNTY Ordinance Codes and Standards, State and Federal laws. <br /> APPLICANT'S SIGNATURE <br /> Title: Date: <br /> AUTHORIZATION TO RELEASE INFORMATION: In addition to the above, when applicable, I, the owner, operator or agent of same, of <br /> the property located at the above site address hereby authorize the release of any and all results, geotechnical data and/or <br /> environmental/site assessment information to SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION as soon as <br /> it is available and at the same time it is provided to me or my representative. <br /> DEADLINE DATES: Inspection: Current / / Prior <br /> Fee Amount Amount Paid Date of Payment Payment Type Receipt # Check # Recvd By <br />
The URL can be used to link to this page
Your browser does not support the video tag.