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SITE INFORMATION AND CORRESPONDENCE
EnvironmentalHealth
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2900 - Site Mitigation Program
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PR0009040
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
10/1/2019 4:59:08 PM
Creation date
10/1/2019 4:49:10 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0009040
PE
2960
FACILITY_ID
FA0004009
FACILITY_NAME
CALIFORNIA FUELS/D ATWATER
STREET_NUMBER
838
STREET_NAME
MOKELUMNE
STREET_TYPE
ST
City
WOODBRIDGE
Zip
95258
APN
01509082
CURRENT_STATUS
01
SITE_LOCATION
838 MOKELUMNE ST
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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PHS/SAN i*WJIN CCUNTY • ENVIRONMENTAL HEALTH DIVISION "saw <br /> CONTAMINATEO SITE 0-Base MFR - INPUT FORM /� <br /> UPDATE: / / 3Y: RE`JIEWED 3Y: DATE ENTERED: /V/�/ Y / 3Y.. <br /> SWEEPS/SITE CODE �(b PROGRAM/ELEMENT d-J� CCMP lOC C00E C� DIST <br /> UGT FILE PIEliZOOLEFILE <br /> ` H W FILE SITE MITIGATIONIde PWS FILE PRIV WELL FILE ENV ASSESS <br /> -tSOLID WASTE EP[ FILE LAND USE FILE I OTHER AGENCY REPORT EMERGENCY RESPONSE <br /> L=AO AGNCY/UNIT V ECCNTACTTH <br /> CNTACT M S OHS!/(OS114POES <br /> OTHER CONTACT RWOC301 V,- Co U� MR issued Y issued Y <br /> FAIL_0 PT ( SOIL CCNT 3.2 5.$ CJ CCHT OW CONT ETROLEUM <br /> I 4Z 03 ,L 5 <br /> Sl:3STANCE �1 �2 Q 3`� <br /> PRICR FAILED PT 40 ACTION CL'cAN LP CCMPL�TE DATE <br /> T;71CRC_MENT ACTION Y / N <br /> ENFORCEMENT TYPE: 1 2 3 L 5 6 DATE ACTION TAKEM: <br /> [CONTACT <br /> ME (� ( �/��QVol ISS 3S �1"�L l V Y ► I �C. St <br /> ��l G.l �l� sTArE � zIP, , 1 NAME W w <br /> PRCPERTY CWNER <br /> T PHONE �[1 <br /> CCMPANY NAME lJ <br /> ------------------- <br /> CCN T ACT NAME � '� _ <br /> Q PHONE <br /> ADDRESS P O IZ <br /> =STATE ZIP �Z� <br /> CITY <br /> A£SPCNSIBLE PARTY (If different from Property Owner) <br /> n <br /> CPANY AE <br /> PHONE <br /> PHONE <br /> NTACT NAE Ai— <br /> C <br /> STATE ZIP 5Z(/ <br /> CITY <br /> CCNA3lTAN7 <br /> GC�V Ir PHONE �lw� gZ Z�l lJ <br /> PROP 65 x �� a OATS l 'f�-�� PRIORITY <br /> UAR t E7O [tel vY It/STRE=7 x SITE STREET J <br /> c3 23 070 (7i89)9E`JISEO 03191 39-19(I'J) CATMFR2 <br />
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