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f RAL PROGRAM FILE : New Change Edit .,,/ (PR()G3) ,revised 5/21/93 <br /> 'E <br /> FACILITY 10 # FACILIT�NAME <br /> ..-... <br /> RECORD ID # ri PRIOR SWEEPS/COMP # f 1 4 <br /> 1.839 <br /> WAGNER CORPORAfION <br /> $17 N.'HUNTER 209-943-6100 # <br /> ' STOCKTON, CA",95202 <br /> � .. , sl..2ulzsorea sr°a M <br /> Npy�mber. 3 g 93 + <br /> ' PAY i <br /> ?OT'HF" y <br /> ot{OF.n Or_�COUNTY OF SAN_.LOAQUTN PUBLIC HEALTiT SERVICE $ 234.00 f <br /> _._ I° E '' ! II ,I i. •n. ', .I ... _ .. DOLLARS <br /> - STOCKTON MAIN OFFICE <br /> WELLS FAR.GO BANK ✓'�j« <br /> A 303 NORTH EL OORADO STREET,STOCKTON.CA 85202 <br /> FOR <br /> 11600''�L839118 18.112 L000 2481:0560 06669,B <br /> SITE MITIGATION: Environ Assess 'J�.". UST/CAP Loc Haz {taste Aai Mat PPL <br /> Other :Lead Agency Site Agency: , RWQC8 DTSC NPL Site R8/N20 0 Other <br /> Ir <br /> " .. <br /> SOLID WASTE., Lendfill ''r Trails#er Sta Recycling Fac waste Storage Fac Ag haste/Exempt Site is <br /> iU Vehicle i No.;'_ Dumpster Md. Stationary Compactor Site L. <br /> VECTOR CONTROL:, Pouftry Farm Max Number of girds Kennel .. - <br /> EMERGENCY NOTIFICATION for.� this FACILITY and/or PROGRAM DAY , L'N'llalHT'v/ <br /> CONTACT 1 - <br /> CONTACT <br /> DESIGNATED EMPLOYE #1 ,� PROGRAM ELEM(14T <br /> # �� CURRENT STATUS <br /> 1 S <br /> # Of UNITS J !� EPA ID #: INSPECTION CODE, <br /> SILLING and COMPLIANCE ACKNOWLEDGEMENT: i, the undersigned owner, operator or agent of samei`bc rok""T site and/or <br /> project specific PHS/EHD fi�ourly charges associated with this facility or activity will be bittedtified as the 21BILLING PARTY ors this fer+ii. 1 also certify that I have prepared this application and that the wor�tcka will be done <br /> in accordance with all applicable SAN JOAQUIN COUNTY Ordinance Codes and/or Standards end State ar�t]A P"al a. <br /> PUBLICSAJOAQUIN COi.INTY <br /> APPLICANT'S SIGNATURE " <br /> Ti t Ie: /L»''��✓'��° � _= <br /> Date: 31 <br /> AUTHORIZATION TO RELEASE INFORMATION: in addition to the above, when applicabte,.:t, the owner, operator or agent of same, a£ ., <br /> the property located at the above site address hereby authorite the release of any and ail results; geotechnical data and/or <br /> environmental/site tassassr�nt lnfaimition to SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES EHVIOMMAL HEALTH OiVl�ION <br /> it is available rand at the same tithe it is provided to me or my representative. <br /> _ 5 <br /> Fee Amount Amount Paid Date of Payment Payment Type `Receipt 0 Check # R vd <br /> llyl <br /> �'A <br /> 'TT <br /> - -,m 11-3 -93 <br /> RENS. h/ / F SUPV / ACCT / j UAIt CLK <br /> l � <br />