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San Joaquin County Environmental Health Department <br /> DATE 5/11/15 MASTER FILE RECORD INFORMATION"MFR" GREEN FORM <br /> - - _ SITE MITIGATION& LOP <br /> SHADMARee req END Use ONLY OWNERIDN CASE# UNIT <br /> IV <br /> OWNER FILE:COMPLETE THEFOLLOW/NG PROPERTY OWNER INFORMATION.' OmEONIF INNER CURRENT'YOUFAEWny END El <br /> PROPERTYOWNER NAME ( 09 461-7315 <br /> FNat MI Last PHGNENUMeER <br /> 6UBINEWNAME Diamond Foods, Inc. E-MAIL ADDRESS <br /> THarding@diamondfoods.com <br /> Owner Home Address <br /> CRY STATE ZIP <br /> Owner Melling Address 1050 S. Diamond Street <br /> Malting Address City Stockton slate CA 7JP95205 <br /> CORMMTMNO INDIVIDUAL El PARTNERSHIP[] Fea AOENOY❑ El <br /> [I <br /> SITE SITE MITIGATION❑ENVIRONMENTAL ASSESSMENTO✓ VOLUNTARY CLEANUP[]WATER QUALITY�HW PIPELINE INVUTMATWN El LOPL <br /> FAOILRYID# INVN AOGOUNTID PR#IRO# ASSI ONEDEMPLOYEE LEAD AGENpY:ENRILIEwacis LVJDTSC EPA <br /> FACILITYFILE COMPLETE THEFOLLOW/NG BUSINESS/FACILITY/SITE INFORMATION: <br /> ISthisaNEW Business LOCATION not previously regulated by the ENVIRONMENTAL HEALTH DEPARTMENT? YES ❑ No 91 <br /> Is this an EXISTING Business LOCATION butte NEW TYPE of regulated Business? YES ❑ No is <br /> BUMNEBWFADILRY/Sm NAME Diamond Foods, Inc. <br /> SITE ADDRESS 1050 S. Diamond Street suRE# BUSINEMPHONE <br /> (209)951-2188 <br /> CRY Stockton CAS ZIP 95205 <br /> BOARD OF SUPERVISOR DISTRICT LOOATIONCODE KEY-1 KEY2 <br /> Mailing Address IfDIFFER£NTfron,FeO11WAddmss Attention:orOare Of(opNoneQ <br /> Mailing Address City STATE ZIP <br /> SICCODE APNN 155-32-019 COMMaR: <br /> THIRD PARTY BILLING INFO: Complete if Billing Party is diKerentfrom Property Owner of-Facility Operator identified above. <br /> BUSINESS NAME Cardno ATC Attention: Oars Of(optional) <br /> Melling Address 1117 Lone Palm Avenue, Suite 201 B PHONE 209.579.2221 <br /> CRY Modesto BTA'E CA 7'P 95351 <br /> AnnMaIMPatzm for fees and Charges OWNER FACILITY/BUSINESS THIRD PARTY BILLING <br /> BILLING AND COMPLIANCE ACRNOWLEDGATEW: 1,the undersigned Applicant,certify that I not the Ouster,Operamry or Aulaodsdrigen�of this Business,and 1 acknowledge that nil PERIHI"FEeA, <br /> F£AALrr£S,EN6bRCEAL£MC'HARCFS and/or HOURLI'C'HAWFe a430da1Ml\whit gills oyes ailing will be billed to ale at lite address Identified all 'e as lheACCUr/w'A UURESS for this site. I also certify(lint <br /> all Information Provided on Ibis nPlslication Is true and correct;and that all regulated activities will be Perforated in accordance with all llPplicnble SANJOAQUIN COUNn'Ordinance Codes and/or <br /> Standards and STATE and/or FEDERAL Laws and Regulations.As the undersigned owner,operator,or agent of the properly located at the drive fncility/sift address,I hereby ouhorise the retreat,of <br /> any...it all results and environmeninl assessment inf...Allen to SAN JOAQUIN COUNTY ENVIRONAIENTAL HEALTH DEPARTI HENT as mon as it is mallable snit at tire some Ilme II is <br /> prow4ded to ase or my ml,remmnlive. <br /> APPLICANT NAME(PLEABE PRINT) Jeanne Hornsey SIGNATURE <br /> TITLE Professional Engineer/ Branch Manager TAX ID#46 3 9408 <br /> AppreanallB Dela A..u.U.0 Mo.Preeguistigi Com hstaid By Data <br /> SITE MITIGATION AMOUNT PAID DATEDFPAYMENT PpYMENTTYPE RECEIPTN CHEON# RECEIVED BY WORK PLAN PE <br /> FEE:$ <br />