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PSAN JOA IN C3UNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> SITE REMEDITATION INFORMATION <br /> Site ID: SDCase ID: RO Existing FA <br /> &�/ 7 7 Facility ID: <br /> SITE INFORMATION <br /> Business Name: (�;b r j p n k�-b <br /> Street#: (fj rj Dir: S Street Name: L) 0 ki Type: <br /> City: V'V l (� + State: CA Zip: S 33 <br /> County: 39-San Joaquin County APN: <br /> CASE INFORMATION <br /> Program Element: 2961 -Cal EPA Voluntary Cleanup Program Assigned Name: �� d a <br /> Regulatory Oversight Program: CALEPA-Cal EPA Voluntary Cleanup Program <br /> Funding for Regulatory Oversight: RP-Responsible Party Funds(CAL EPA) <br /> Funding for Cleanup: RP-Responsible Party Funds <br /> File Location: L-Local Agency <br /> RISK MANAGEMENT <br /> ❑ A-Drinking Water Supply Aquifer Affected [IF-Surface Water .S-Soil Only <br /> Case Type: <br /> ❑ W-Drinking Water Well Affected N�U-Undetermined Affected <br /> Beneficial Use: MUN-Municipal and Domestic Supply <br /> Vulnerability Basis: 3-Leak site above an aquifer used as a source of a community water system <br /> MTBE Threat Classification: NA-No MTBE Contamination <br /> Number of Impacted Wells: 0 Well Impact Description: None <br /> CASE MANAGEMENT <br /> Brownfield: ® Y-Site is part of Brownfield Site Management Requirements: NA-No Action <br /> Current Land Use: ❑ Agricultural ❑ Commercial ❑ Industrial ❑ Public Use 0 Residential <br /> ® Exclude from Export **This box must be checked for P/E 2961 sites.** <br /> Completed By: ( ���' Date: <br /> Entered By: Date: <br /> EH-29- <br /> 09/18/2007 <br />