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SITE INFORMATION AND CORRESPONDENCE
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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88 (STATE ROUTE 88)
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13731
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2900 - Site Mitigation Program
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PR0527274
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
11/20/2024 9:23:29 AM
Creation date
9/5/2019 11:07:07 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0527274
PE
2950
FACILITY_ID
FA0018473
FACILITY_NAME
OMEGA VINEYARDS
STREET_NUMBER
13731
Direction
N
STREET_NAME
STATE ROUTE 88
City
LODI
Zip
95240
APN
06316031
CURRENT_STATUS
01
SITE_LOCATION
13731 N HWY 88
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> SITE MITIGATION MASTERFILE RECORD FORM <br /> GENERAL PROGRAM FILE: New- Changs Edit <br /> (PROG4) revised g/23/94 <br /> FACILITY ID k rA ENE]FACILITY NAMERECORD ID k PRIOR DIST k fill PRIOR SWEE S k <br /> ite Mitigation: x ironmental Assessment ST/CAP cal Hazardous Waste Invest <br /> zMa[ Pipeline Invest <br /> Ll Cher Lead Agency Site gency: WQCB DTSC EPA L Site ater <br /> Quality Site Cher Type Site <br /> EDESIGNIATED k � PROGRAM ELEMENL k CURRENTSTATUS <br /> EPA ID k: INSPECTION CODE <br /> ed to this PROGRAM record <br /> BILLING ACKNOWLEDGEMENT: 1, the undersigned owner, operator or agent of same, acknowledge that all site and/ project specific <br /> PHS-END 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: <br /> 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 Amounc Amount Paid Date of Payment Payment Type Receipt K Check k Recvd 8 <br /> Y <br /> ?/Z-7/67 < « X35`► l�/� <br />
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