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SITE INFORMATION AND CORRESPONDENCE
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2900 - Site Mitigation Program
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PR0515453
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SITE INFORMATION AND CORRESPONDENCE
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Entry Properties
Last modified
12/11/2019 5:02:52 PM
Creation date
12/11/2019 4:21:31 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0515453
PE
2950
FACILITY_ID
FA0012156
FACILITY_NAME
NORTH SHORE PARCEL
STREET_NUMBER
0
STREET_NAME
FREMONT
STREET_TYPE
ST
City
STOCKTON
Zip
95202
CURRENT_STATUS
01
SITE_LOCATION
FREMONT ST
QC Status
Approved
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Tags
EHD - Public
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B-25-1999 11 :09AM FROM �A P. 2 <br /> RES-----;x-�rw <br /> fITE?IVtSTWb t1 <br /> DATE MASTER FILE RECORD INFORMATION "MFR" - GREEN FORM <br /> UNIT IV <br /> SMYOEG AREAS FOR ENO U.0 ONLY <br /> W l <br /> OWNER FILE <br /> COMPLETE rHEFOLLOW/NG PROPERTY OWNER /NFORMA 7/ON: CHeuiF OWNER CU9R9vrtrO,VrLzwrNEHD <br /> PROPSRTT 11ff J � �/J i PHONE/ / <br /> OWNERNAME CI }I rO✓kgol\ <br /> GYN I rR �xf <br /> BUSINESS NAME SOC SEC/TAX ID it <br /> Owner Home Address 363 ay f / DRIVER'S LICENSE Y <br /> city 12� STATEC <br /> Omer Mearns Add—.. <br /> Mailing Address City $tate Zip <br /> CORPORATIONI 1lINOIVIOVAL❑ PARTNERSHIPFED AGENCY OT. <br /> fR I/•f <br /> FACILITY FILE <br /> .....:. a:.V`A,�4l�rrn XP"a. v.q•:. r ';1xglY. w,M71 N,E�a,�Hj. K7h'YL'1'jlRq�ps.'hZ AI! r I. :. <br /> tv1C1Vta'117/as�l �" CR6M1iFa +..."l..Y iY.n RCCt'OO11Y.Ir7• ' �' ,A �I" .N'W:.viN"V n!:�+^e.'i.U1L r 4`I,�'ri• -0 i .::r'� <br /> :OMPLETE rHEFOLLOW/NG BUSINESS / FACILITY/SITE /NFORMATION: <br /> Is this a New Business LOCATION not previcuaty regulated by the ENVIRONMENTAL HEALTH DIVISION? Yrs ❑ No <br /> f <br /> Is Na an EAeTINo Business LOGT/// <br /> ,11 <br /> 1E tON Out a NEw TYPE of regulated business T YES NO W <br /> buSIwess/FACILITT/SITE NAME A&/w <br /> 51AOORESS /V I /�(I�M 1 ✓� Tf a /LL ttJOV�17IGtM t1h T 1 <br /> CITY STATE A zjPCj5 7.t22- <br /> 711 <br /> BOANOOFSOPERVISOR�...��u_L_ ._�-L...:1G4- ',TIO.N;.._.:_ <br /> MaRing A areas i/D/FFERENr Gam Faci/ily Address / Attention: or Care Of(opUona/J <br /> n�z twl (E�7 Z (,r7VUctn 5 F• �t ea Se <br /> Mailing Address City S p STATE CI A zip q 5 202 <br /> "HIRD PARTY BILLING INFO: Complete if Billing Party is different from Property Owner or Facility Operator identified above. <br /> Su .ESS NAME Attention: or Care Of Wdonal) <br /> Mailing Address PHONE <br /> Crrr STATE Zip <br /> ACOouArrADoRF55 for fees and chargesOWNER FACILmBusmEss THIRD PARTY BILLING <br /> u.INOcA4H�p�COMPLu�Ca AC NOWLEDOMCNT: L the aadeesigncd AppR « eon4 rtify that ism the Own",npww,or Aarhor$ed1lifew of Ibb basina <br /> .And 1 acknowledge that A <br /> 'RN?l.....ftwA rfet,EY/ORCGNEK CFUR(iCe and/or Iluvw.y CRAAYiLS laNreiaf d with this operation will be biped m me at the address Ide atlfled above M the Acwt/,VTApDR6SS <br /> r Chia sibs I xlw certify that all information provided on this appliotion Is true Ind correct:mad that till regulated Activities will be performed in seenrdsnee with all appliQible S,LV <br /> rwQIIH COVNrr Ordioance Cedes muVor Standards and ST%TD and/or FI:DKu L Law%add R4XUfAliOn} As on undenir+nod wnu,operator,or agent of the property looted nt the <br /> were faolly/sire addreu, i bereby aumohs the refeaae of any and W resale, and cavueaIn oul asaeumeet lorormadoo w SAN JOAQUIN COUNrY F-NVtRONME.NT.M. <br /> EALTH DIVISION w soon"it is available and At the same Time it M provided m me or my representative <br /> ..GG .?` (��PL/eASe PLANT J ,/ <br /> APPLICANT NAME G)w5 FIS � " SIGNATURE <br /> TITLE -�f �Y)C AJ Ar(71�, DRIVER'S UCENSEp <br /> hElOrocorT RrOurRrnl <br /> �a'N^o^^�`ra �f:Vill,: ^.tee ♦ v t ^^'M'J•. - rb hr ' <br /> APproved�6YYrNA•�Y~ir«.`ue7,i!Da .su:._:- s-::�i'—' '+Accounlhlq dHfoe?rooasaMg Co�iapkt�ad�l�•+Y�':. +_�•°•. �Saltr`:I r ;: ;...: <br />
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