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SITE INFORMATION AND CORRESPONDENCE
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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3500 - Local Oversight Program
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PR0545523
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
3/13/2020 4:36:02 AM
Creation date
3/12/2020 10:38:16 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0545523
PE
3528
FACILITY_ID
FA0009394
FACILITY_NAME
MAXIM CRANE WORKS
STREET_NUMBER
2373
Direction
E
STREET_NAME
MARIPOSA
STREET_TYPE
Rd
City
Stockton
Zip
95205
CURRENT_STATUS
02
SITE_LOCATION
2373 E Mariposa Rd
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\sballwahn
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EHD - Public
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5' MITIGATION ACKNOWLEDGMENT/REQUEST FOR SERV,' ',FORM <br /> SAN JOAQQWoOUNTY PUBLIC HEALTH SERVICES/ENVIIONMENT LTH DIVISION <br /> SITE INFORMATION THER LEAD AGENCY <br /> ITE NAME HUSKY CRANE AGENCY CONTACT <br /> PHONES' <br /> DRESS 2373 MARIPOSA ROAD APN M pp >o <br /> I <br /> r ITr $TOCKTON; CALIFORNIA %. a IP 95205 <br /> 102- 34P I <br /> BILLING / RESPONSIBLE PARTY INFORMATION <br /> AMB HUSKY CRANE ) DEC 1 3 1991 <br /> (LING ADDRESS 2373 MARIPOSA ROAD ENVIRONMENTAL HEALTH <br /> -'I TY STOCKTON ) TATE CA IP 95205 <br /> oNTACT NAME HIM BAILEY, "_Secretary jf ONE (209) 464 7635 <br /> PROPERTY OWNER/OPERATOR <br /> AME HUSKY ANEHONE 9 6 <br /> 35 <br /> DD RE ss 2 MARIPOSA ROAD <br /> ITY STOCKTON TATE CA IP 95205 <br /> CLIENT INFORMATION (IF DIFFERENT FROM CWNER/OPERATOR) <br /> AME HONE <br /> OORESS <br /> ITr IP <br /> AUTHORIZATION TO RELEASE/BILLING ACKNOWLEDGEMENT <br /> I, 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 ASSESSMENT INFORMATION TO <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES, ENVIRONMENTAL HEALTH DIVISION AS SOON AS IT IS AVAILABLE AND AT THE SAME TIME IT 1S <br /> li <br /> PROVIDED i0 '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 /> i <br /> DHS/END HOURLY CHARGES ASSOCIATED WITH THIS ACTIVITY WILL BE BILLED TO THE PARTY IDENTIFIED ABOVE AS THE "RESPONSIBLE PARTY". <br /> I <br /> i <br /> APPLICANT'S NAME, TITLE, SIGNATURE/DATE <br /> AME l SN <br /> it l2� 13 �R( <br /> IGNA TORE I ATE <br /> OMPANY Husky Crane, Inc ITLE Secretary <br /> I <br /> 89-007(IV)12/908ILFRM12 <br /> • EN 29 01 <br />
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