Laserfiche WebLink
a SAN JJAQUIN COUNTY ENVIRONMENTAL HEALTH RARTMENT <br /> DATE MASTER FILE RECORD INFORMATION E'MFRJ' GREEN FORM <br /> SITE MITIGATION & LOP <br /> SHADED MEAS FOR END USE ONLY OWNER ID# DABEIt SRm 44 13 UNIT IV <br /> OWNER FILE:COMPLETE PROPERTY OWNER/RESPONSIBLE PARTY INFORMATION: C//ECAfIPOWAIFRISCURREHTLYOHFILEwrH EHD <br /> PRovetty OWNER NAME City of Ripon (209) 599-2108 <br /> FMST MI LAST PHONE NUMBER <br /> BUSINESS NAME E4AAIL ADDREM <br /> City of Ripon Rights-of-Way kwerner@cityofripon.org <br /> OWNER HOME ADORESS <br /> COY STATE LP <br /> OWNERMULINGADDRESS 259 North Wilma Avenue <br /> MNLING ADDRFM CITY $TATE 7JP <br /> Ripon CA 95366 <br /> ❑CORPORATION ❑INDIVIDUAL ❑PARTuounim P ❑GOVERNMENT AGENCY ❑RESPONSIBLE PARTY Igl thNER <br /> SITE MITIGATION_ENVIRONMENTAL ASSESSMENT X VOLUNTARY CLEANUP_WATER QUALITY_HW PIPELINE INVESTIGATION LOP <br /> FACIUTYID# INV# ACCOUNT ID PR# ROY ASSIGNED EMPLOYEE LEAD AGENCY:EHO_RWOCB—LDISC_EPA <br /> _ <br /> & q5 (.4((3 oS/ 1 Ja 4jwv <br /> FACILITY FILE:COMPLETE BUSINESS/SITE/PROJECT INFORMATION: <br /> IS THIS A NEW PROJECT LOCATION I_IQT PREVIOUSLY REGULATED BY THE ENVIRONMENTAL HEALTH DEPARTMENT? YES ,y❑y No <br /> IS THIS AN EXISTNO PROJECT LOCATION,BUT A NEW SCOPE OF WORK? YES Ey NO ❑ <br /> BUSINESSIFACILITY/SITEIPROJECT NAMe Business: Nestle USA, Inc. Facility: Former Nestle USA, Inc. Facility <br /> SITEAODRESS/PRweCTLOGArDIH SUIR# BUMNM PHONE <br /> 230 Industrial Avenue <br /> Cm Ripon 8TAT1 zip <br /> CA 95366 <br /> BOARD OF SUPERVISost Dsrnlcr S LOCATION CODE KEY1 KEY2 <br /> MAILING ADDRESS,IF DIFFERENT FROM FACILITY ADDRESS ATTENTION:MCARE OF(OPr/O,WLf <br /> 800 North Brard Blvd Marie Joachim <br /> MAILING ADDRESS CITY STATE 7JP <br /> Glendale CA 91203 <br /> SIC CODE APNY Row COMMENT: <br /> THIRD PARTY BILLING INFO:COMPLETE IF BILLING PARTY IS DIFFERENT FROM PROPERTY OWNER OR RESPONSIBLE PARTY IDENTIFIED ABOVE. <br /> BUSINESS hime Environmental Cost Management, Inc. ATTENnON:GRCARE OF(6FTIaAm) <br /> Binayak Acharya <br /> MAILING ADDRESS PHONE <br /> 3525 Hyland Avenue,Suite 200 661-255-1693 <br /> Cm Costa Mesa BCA 9TATE 2626 <br /> ACCOUNTADORESS TO SEND FEES AND CHARGES: OWNER❑ FACILITY/BUSINESS❑ THIRD PARTY BILLING® <br /> BUUL1NG AND COMPLIANCE ACKNOWLEDGMENT: I,the undersigned Applican4 certify that Imo the Owner,Operator,Amhor1;ed Agen4 or rtesponslf fe Party and I acknowledge that all FR TTPEE4, <br /> PENALTIES,EN£ORC£AENTCHARGER and/or HOCRLY CHARGES associated With this project will be baled tome at the addrest identified above ea the AccwD ADDRESS for this site I alw verDty that aU <br /> Information provided on this application Is true and correct;and that all regulated activities will be performed In accordance with ell applicable SAN JoAQlml Cosmry Oomousb E Conn and/or <br /> SrknA and STALE and/or FYDERAL Laws and REGULATONS. As the undersigned Owner,Operamq Amhor1redAgeu4 or Rapamibk Parry for the project located above under faculty/site address,I <br /> hereby authariu the release of any and ail results,reports,and other environmental assessment Information to SAN JOAQUIN COUNTS ENVIRONI ffiNTAL HEALTH DEPMTAIENT as soon as It ts available <br /> and at the same time It Is provided to me or my representative <br /> APPucANTNAME(PLEASEPRINr) Binayak Acharya SIONATYRE 24=#--.- <br /> TITLE NestI6 Program Manager TAxID# ECM Tax ID:20-4078378 <br /> APPROVEDBY DATE ACCOUNDNG OFTeE PROCERBINO COYPLRaEO By DATE <br /> SITE MTIGATAMOUNT PAID DATE OF PAYMENT PAYMENT TYPE RECEIPT Y CHECK# RECEIVED BY WORK PLAN PE <br /> FEE:$ 3-27 /�9 ( O <br />