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SU0011816 SSNL
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SU0011816 SSNL
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Last modified
5/7/2020 11:35:28 AM
Creation date
9/4/2019 11:32:46 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
FileName_PostFix
SSNL
RECORD_ID
SU0011816
PE
2622
FACILITY_NAME
PA-1800022
STREET_NUMBER
11418
Direction
E
STREET_NAME
COMSTOCK
STREET_TYPE
RD
City
STOCKTON
Zip
95215-
APN
08913028, 08913057
ENTERED_DATE
6/13/2018 12:00:00 AM
SITE_LOCATION
11418 E COMSTOCK RD
RECEIVED_DATE
6/11/2018 12:00:00 AM
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\C\COMSTOCK\11418\PA-1800022\SU0011816\SS STUDY.PDF
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EHD - Public
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SAN JOAQUIN COUNTY ENVIRO IFALTHDEPARTMENT <br /> SERVICE VEST <br /> Type of Business or Property FACILITY ID# SERVICE REQUEST# <br /> OWNER/OPERATOR <br /> Lucia Grillo CHECK If BILLING ADDRESS <br /> FACILITY NAME Grillo / Podesta Property <br /> SITE ADDRESS 11418E. Comstock & 6655 N. Beecher Stockton 95215 <br /> Street Number Direction I Street Name City Zip Code <br /> HOME or MAILING ADDRESS (If Different from Site Address) 7198 N. Tully Rd. <br /> Street Number Street Name <br /> CITY Linden STATE CA Zip 95236 <br /> PHONE#1 EXT. APN# LAND USE APPLICATION# <br /> (209) 931-1366 089-130-28 & -57 pAr I Ir6oaZ Z <br /> PHONE#2 EXT BOS DISTRICT LOCATION CODE <br /> CONTRACTOR/ SERVICE REQUESTOR <br /> REQUESTOR <br /> Abby Racco CHECK If BILLING ADDRESS <br /> BUSINESS NAME PHONE# EXT. <br /> Live Oak GeoEnvironmental 209 369-0375 <br /> HOME or MAILING ADDRESS FAX# <br /> 407 W. Oak St. ( ) <br /> CITY Lodi STATE CA Z'P 95240 <br /> BILLING ACKNOWLEDGEMENT: I, the undersigned property or business owner, operator or authorized agent of same, <br /> acknowledge that all site and/or project specific ENVIRONMENTAL HEALTH DEPARTMENT hourly charges associated with this project <br /> or activity will be billed to me or my business as identified on this 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 JOAQUIN <br /> COUNTY Ordinance Codes,Standards, STATE and FEDERAL laws. <br /> APPLICANT'S SIGNATURE: DATE: <br /> PROPERTY/BUSINESS OWNER❑ OPERATOR MANAGER ❑ OTHER AUTHORIZED AGENT P C D Nd U L-77?'T <br /> IfAPPL/CANT is not the BILLING PARTY,proof of authorization to sign is required Title <br /> AUTHORIZATION TO RELEASE INFORMATION: When applicable, I,the owner or operator of the property located at the <br /> above site address, hereby authorize the release of any and all results, geotechnical data and/or environmental/site assessment <br /> information to the SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT as soon as it is available and at the same time it is <br /> provided to me or my representative. <br /> TYPE OF SERVICE REQUESTED: Review Soil Suitability Study RECEDIED <br /> COMMENTS: <br /> NOV 2 8 2018 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> /,� HEALTH DEPARTMENT <br /> Z3 l (®U <br /> ACCEPTED BY: EMPLOYEE M DATE: <br /> ASSIGNED TO: EMPLOYEE M DATE: <br /> Date Service Completed (if already completed): SERVICE CODE: r P I E: <br /> Fee Amount: v Amount Paid 3 p Payment Date <br /> Payment Type \ Invoice# Check# Ste, �� ? Received By: <br /> EHD 48-02-025 SR FORM(Golden Rod) <br /> REVISED 11/17/2003 <br />
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