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SITE HISTORY
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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COPPEROPOLIS
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10848
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2900 - Site Mitigation Program
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PR0536777
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SITE HISTORY
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Last modified
6/18/2019 11:19:18 AM
Creation date
6/18/2019 11:09:25 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE HISTORY
RECORD_ID
PR0536777
PE
2960
FACILITY_ID
FA0021126
FACILITY_NAME
FORMER COUNTRYSIDE MARKET
STREET_NUMBER
10848
STREET_NAME
COPPEROPOLIS
STREET_TYPE
RD
City
STOCKTON
Zip
95215
APN
10311006
CURRENT_STATUS
01
SITE_LOCATION
10848 COPPEROPOLIS RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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I <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> (2W) 468-3420 <br /> AUTHORIZATION TO RELEASE' <br /> • ANALYTICAL RESULTS <br /> GEOTECHNICAL DATA <br /> ENVIRONMENTALlSITE ASSESSMENT INFORMATION <br /> 1. T1 iE UNDERSIGNED OWNER AND/OR OPERATOR OF THE PROPERTY AND/OR FACILITY <br /> LOCATED AT I 0 ? 4 R F ( Z f hz-i-06-36 LIS :& <br /> (Sime!Address) City) <br /> IIEREBY AUTHORIZE ly��CA�.-ot�ErL i� 1 AC-4-MC,4( _. <br /> ( ) <br /> TO RELEASE ANY AND ALL ANALYTICAL INFORMATION TO SAN JOAQUIN COUNTY PUBLIC <br /> I IELTH SERVICES AS SOON AS IT IS AVNLABLE AND AT THE SAME TIME IT IS PROVIDED <br /> '1'0 ME OR MY REPRESENTATIVE. <br /> BUSINESS NAME: - <br /> (If A licatk) <br /> OWNER/OPERATOR. Ti9y- r <br /> (Please Print) (Title) <br /> OwaedOperator Signature) <br /> ADDRESS: - <br /> ( aiUng Address/ r��y � <br /> (City) (Stare) (Zip Code) <br /> PHONE: ( 4,as <br /> DATE: I - q �l3 <br /> LII 23 041 (Revisc4 7-1092) PP`o 9 <br />
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