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SITE HISTORY
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EHD Program Facility Records by Street Name
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1930
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2900 - Site Mitigation Program
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PR0527262
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SITE HISTORY
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Entry Properties
Last modified
1/9/2020 2:33:29 PM
Creation date
1/9/2020 2:25:26 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE HISTORY
RECORD_ID
PR0527262
PE
2950
FACILITY_ID
FA0018463
FACILITY_NAME
SWIFT ROOFING
STREET_NUMBER
1930
Direction
W
STREET_NAME
FREMONT
STREET_TYPE
ST
City
STOCKTON
Zip
95215
APN
13336033
CURRENT_STATUS
01
SITE_LOCATION
1930 W FREMONT ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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Aug. 13, 7007 9CAM A+— �iced GeaEnvironmental No. 944'7 P. 4 <br /> TATA CALIFORNIA WATER RESOURCES CONTROL BOARD <br /> FORM 'A'. UNDERGROUND STORAGE TANK PROGRAM <br /> E (FACILITY/SITE, INFORMATION and/or PER <br /> APPLICATION <br /> SIT <br /> T14IS FORM FOR EACH FAC <br /> ItIT <br /> 7 PERMANSMiLY CLOSED$ITE <br /> N1iARK f]NtY <br /> I FJEw PER :IT 7,$'RENEWAL PERMIT S CHANGE Of IJROAMATION <br />' ONE ITEBIt �2 ifiJ7FRII�PERMIT �4 AMENDED?ERMIT �6 TEMPORARY SITE CLOSllRE <br /> 1. FACILITY/SITE INFORMATION&ADORESS — (MUST 9E COMPLETED) t;E <br /> CARE of ADD96ES NYOnMA7V0t/� <br /> FACILITY/51'(E NAME - r� <br /> -NEAREST CR065STREET POFNEASiVP ❑ S1AFEIGENLr <br /> ADDRESS _ n CDAP9'PAF10A L LOG4-AC:FNCY ClFEDERAL-MENU <br /> _ �� f V c N�IVYOUtiL. ❑ CWNNAMLf <br /> zip 000E SIT£FN NE#.WITH AREA CODE <br /> STASk I <br /> cm NAME CA �� �"� �LIC t -Q 7 <br /> • '�-� ESA)n x �. <br /> YYPE OF BV51NE56' a 0ISTBIBUTCR 4 PROCESSOR' ✓Box V INDIAN - I!of TANI <br /> ❑^ 5 aTHEA RRUS YATIONLAMOS Or ❑ • AT YNIS SITE <br /> I GASSTATiON 3 Wki <br /> kIERGENCY CONTACT PERSON(ppiMARYI EMERGENCY CONTACT PERSON(SECONDARY) <br /> E PtvONE A VM H AREA CODE <br /> DAYS: NAME(4A$T,'FIR3TI rPP//HO14E M WfTH AREA CODE GAYS',- NAME(LA5T FIRST) <br /> Py10NE n WIT1i AREA CODE <br /> -FP NEM WITH AREA GODS NIGHTS NAME(LAST,fIRST) <br /> NI6PiT9 NAMtiE(LASE VRST) <br /> 11, PROPERTY OWNER INFORMATION& ADDRESS--(MUST BE COMPLETED) <br /> `•ARE'OF ADDRESS INFOAMAT4ON <br /> II NAME hh ,/ — <br /> �l ❑ STATE-AGENCY <br /> MAILING ar STREET ADDRESS ✓Box to indiC810 ❑ PARTNERSHIP <br />` J ❑ CORPCRA-110N ❑ LOCAL-AGENCv 11 FFI7F.RaL.A(iENCY <br /> F R t1 .� �-ifIDkVIDURL ❑ C.QW1Y.AGENCY <br /> �J� STATE lIP C4OOE NEP 11TH AREA COLE <br /> CITY NAME <br /> 3 Ill. TANK OWNER INFORMATION &ADDRESS—(((RUST RE COMPLETED) <br /> cnHE aF ADDRESS wFOR�lAnorJ <br /> NAME. <br /> Ph U <br /> MAILINQ or STR�EY ADORE ✓box ld inGicnlz Q PAR FNERSH1p ❑ fiYATE-A <br /> - Q CgRFORAYVQN LOCAL•AOENCY ❑ FEDERAL-A%•ADkNCY <br /> E� INDIVVGUAL COUNTY-AGENCY <br /> $1'ATF ZIS CODE PHONE I,WITM AREA CODE <br /> cITY NAME <br /> IV_ LEGAL NOTIFICATION AND BILLING ADDRESS <br /> CHECK ONE(i)BOX INDICATING WHICH AE4YE ADDRESS SHOULD K USED FDR EOTN LEGAL NOTIFICATION ANO BILLING'.1, <br />( THIS FORM HAS BEEN COMPLLT EO PENALTY 05 PEPJURY,AND TO THF BEST OF tiff KNOWLEDGE,fS TRUE AND CCAREGT, <br /> DATE <br /> APPLICANT'S NAME TRUJTED&S13NATi1RE) <br /> LOCAL AGENCY USE ONLY <br /> COUNTY A JURISDICTION 0 AQENCY N <br /> 1 KFLItY ID k If Of TANKS aI SITE <br /> - <br /> APPROVED PHONE R WITH IOWA tone <br /> -�.� <br /> CURRENT LOCAL ADENCY FACILITY ID>r � <br /> —P— IPERNIfT EXPIRATION DATE <br /> PER I EAw"— -~ PERMIT APPR6YAL DATE <br /> I <br /> S\ LOCATION CODE f:EN9r16 TRACT II Si1PE`.RV19QR'018YFIICT DOGE EU9FNE$S ALAN FILED <br /> DATE FILE <br /> YEf) El NO <br /> FEE CODE FFECEIPT N BY: <br /> 1X.I CHECK IF P£AYIT AA OUNT 9URGFIARGE AMOUNT <br /> / <br />{ \V THIS FORM MOST BE ACCOMPANIED BY AT LEAST(1)OR 96RE TANK PERMIT FORM`Bl APPLICATION(Sk UNLESS TRIS IS A CHANGE OF EffTE INFORMATION ON <br /> t; FORM A 0-2-86) <br /> DATA PROCESSING COPY <br />
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