My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
SITE INFORMATION AND CORRESPONDENCE
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
N
>
NAVY
>
3019
>
2900 - Site Mitigation Program
>
PR0507169
>
SITE INFORMATION AND CORRESPONDENCE
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
10/2/2019 5:04:30 PM
Creation date
10/2/2019 4:57:08 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0507169
PE
2950
FACILITY_ID
FA0007724
FACILITY_NAME
HYDRO-AGRI
STREET_NUMBER
3019
STREET_NAME
NAVY
STREET_TYPE
DR
City
STOCKTON
Zip
95201
CURRENT_STATUS
02
SITE_LOCATION
3019 NAVY DR
QC Status
Approved
Scanner
SJGOV\wng
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
21
PDF
View images
View plain text
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> SITE MITIGATION MASTERFILE RECORD FORM <br /> GENERAL PROGRAM FILE: NewChange edit (PROG4) revised 5/23/94 <br /> FACILITY ID # O� '% FACILITY NAME <br /> RECORD ID # / /� PRIOR DIST # PRIOR SWEEPS # <br /> Site Mitigation: Environmental Assessment T/CAP ocal Hazardous Waste Invest �azMat Pipeline Invest <br /> Other Lead Agency SiteAgency: �WQCB OTSC EPA PL Site Flr Quality Site her Type Site <br /> DESIGNATED EMPLOYEE # 0 y PROGRAM ELEMENT # �j C� CURRENT STATUS <br /> NUMBER OF UNITS : EPA ID #: INSPECTION CODE <br /> Number of TANKS linked to this PROGRAM record <br /> BILLING ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site and/or project specific <br /> PHS-EHD 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: Date: <br /> AUTHORIZATION TO RELEASE INFO ION: In addition to the above, when applicable, I, the owner, operator or agent of same, of <br /> the property located at the ove site address hereby authorize the release of any and all results, geotechnical data and/or <br /> environmental/site asse ment information to SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION as soon as <br /> it is available an t the same time it is provided to me or my representative. <br /> DEADLINE DATES: Inspection: Current / / Prior <br /> Fee Amount Amount Paid Date of Payment Payment Type Receipt # Check # Recvd By <br /> NZ 7/30/y7 <br />
The URL can be used to link to this page
Your browser does not support the video tag.
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).