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SITE INFORMATION AND CORRESPONDENCE
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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JACK TONE
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13475
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3500 - Local Oversight Program
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PR0545314
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
2/11/2020 10:29:58 PM
Creation date
2/11/2020 9:42:01 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0545314
PE
3528
FACILITY_ID
FA0005333
FACILITY_NAME
JACKPOT
STREET_NUMBER
13475
Direction
N
STREET_NAME
JACK TONE
STREET_TYPE
RD
City
LODI
Zip
95240
APN
06326004
CURRENT_STATUS
02
SITE_LOCATION
13475 N JACK TONE RD
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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PUBLIC; HEALTH SERVICES <br /> JOGI I1HANNA 1i.D.;<i.P H. <br /> Healrh 0.ficer <br /> P.O. Box 2009 i (1601 East Hazelton Avenue) • Stockton, California 95201 e4<«o-10 ¢ <br /> (209) 468-3400 <br /> JUL 2 6 199'1 <br /> ANASTASIA E DUARTE <br /> TIME OIL CO Fly <br /> 2737 W COMMODORE WAY <br /> SEATTLE CA 98199-1233 <br /> RE: Jackpot SITE CODE: 1635 <br /> 13475 N. Jack Tone Rd. CONTRACTOR #: 39000 <br /> Lodi, CA 95241 <br /> The attached "Notice of Reimbursement" is official notification that your site has been assigned to the San <br /> Joaquin County Public Health Services, Environmental Health Division's Local UST Oversight Program <br /> for oversight of assessment and clean up activities at contaminated underground tank sites. <br /> Fees for review activities and inspections associated with contaminated site assessment activities will not be <br /> billed by this office. The State Water Resource Control Board (SWRCB) will invoice you directly for <br /> activities performed under the auspices of the Local UST Oversight Program. The goal of the site <br /> evaluation performed by Public Health Services Environmental Health Division (PHS/EHD) is to certify <br /> closures of underground tank leakage sites. Closure certification occurs only after mitigation activities are <br /> completed. <br /> A Letter of Acknowledgment is enclosed for your completion and return. Your acknowledgment of the <br /> placement of your site into the Local UST Oversight Program as stated above is respectfully requested. In <br /> addition, the individual or individuals authorizing the continued investigation shall provide identification <br /> with respect to their title of authority. <br /> In addition, this Acknowledgment indicates that the "Regional Board Staff Recommendations For Initial <br /> Evaluation and Investigation of Underground Tanks" and "Appendix A" reporting format and the LUFT <br /> Manual will be utilized as guidance documents in the preparation of work plans and/or reports. <br /> If you have any questions or there are any corrections in the responsible party information, contact Harlin <br /> Knoll, REHS, at (209)468-3442. <br /> Jogi Khanna, M.D., M.P.H. <br /> Health Office ' <br /> urie A. Cotulla, REHS, Program Manager <br /> nvironmental Health Division <br /> LAC/i-II�:nr - <br /> Enc. <br /> c: SWRCB, Underground Storage Tank Section <br /> c: CRWQCB, Central Valley Region <br /> Division of San Joaquin County Hcahh C;arc.k-rvicc.1s <br /> w <br />
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