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SITE INFORMATION AND CORRESPONDENCE
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2900 - Site Mitigation Program
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PR0543355
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
2/6/2020 12:52:34 PM
Creation date
2/6/2020 11:47:15 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0543355
PE
2965
FACILITY_ID
FA0005302
FACILITY_NAME
SPRECKELS SUGAR COMPANY
STREET_NUMBER
20500
STREET_NAME
HOLLY
STREET_TYPE
DR
City
TRACY
Zip
95304
APN
21216010
CURRENT_STATUS
02
SITE_LOCATION
20500 HOLLY DR
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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FOR SERVICES*RM <br /> SITE MITIGATION ACKNOWLEDGMENT/REQUEST <br /> SAN JOAQUIN COUNTY - PUBLIC HEALTH SERVICES/ENVIRONMENTAL HEALTH DIVISION <br /> SITE INFORMATION yL <br /> THER LEAD AGENCY <br /> ITE NAME Holly Sugar Corporation AGENCY CONTACT <br /> PHONE <br /> DDRESS 20500 Holly Drive APN # <br /> ITY IP 95378 <br /> Tracy, CA <br /> BILLING / RESPONSIBLE PARTY INFORMATION <br /> AME Holly Sugar Corporation <br /> AILING ADDRESS P.O. BOX 60 <br /> ITY Tracy, TATE CA TIPT95378 <br /> ONTACT NAME Matthew G. Fenske HONE (209) 835-3210 <br /> PROPERTY OWNER/OPERATOR <br /> AME Imperial Holl Cor oration HONE <br /> DDRESS <br /> ITY TATE iP <br /> CLIENT INFORMATION (IF DIFFERENT FROM OWNER/OPERATOR) <br /> AME HONE <br /> DDRESS <br /> ITY TATE IP <br /> AUTHORIZATION TO RELEASE/BILLING ACKNOWLEDGEMENT <br /> 1, THE UNDERSIGNED OWNER, OPERATOR, CLIENT, OR AGENT OF SAME, OF THE PROPERTY LOCATED AT THE ABOVE SITE ADDRESS HEREBY <br /> AUTHORIZE THE RELEASE OF ANY AND ALL ANALYTICAL RESULTS, GEOTECHNICAL DATA AND/OR ENVIRONMENTAL/SITE ASSESS14ENT INFORMATION TO <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES, ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT IS <br /> PROVIDED TO ME OR MY REPRESENTATIVE. <br /> ADDITIONALLY, I, THE UNDERSIGNED OWNER, OPERATOR, CLIENT, OR AGENT OF SAME, ACKNOWLEDGE THAT ALL SITE AND/OR PROJECT SPECIFIC <br /> PHS/EHD HOURLY CHARGES ASSOCIATED WITH THIS ACTIVITY WILL BE BILLED TO THE PARTY IDENTIFIED ABOVE AS THE "RESPONSIBLE PARTY". <br /> APPLICANT'S NAME, TITLE, SIGNATURE/DATE <br /> 'AME Ma e . Fenske s# <br /> I GNATURE ATE 10/21/92 <br /> Western Division <br /> OMPANY Imperial Holly Corp. ITLE Environmental Engineer <br /> 89-007(IV)12/90BILFRM12 <br />
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