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SAN JOAQUIN COUNTY PUBLIC HEALT3 SERVICES <br /> RECEIVED <br /> ENVIRONMENTAL HEALTH DIVISION <br /> SITE MITIGATION MASTERFILE RECORD FORM N O V 12 1999 <br /> ENVIRONMENTAL HEALTH <br /> PERMIT / SERVICES <br /> GENERAL PROGRAM FILE: Vew1 Change Edit (PROG4) revised 5/23/94 <br /> FACILITY 1D # // ' FACILITY NAME 1 AKRSPUR ESTATES <br /> RECORD ID # V PRIOR DIST # PRIOR SWEEPS <br /> YMa.-Avt� + vc c Pf co , <br /> Site Mitigation: XX Environmental Assessment ST/CAP cal Hazardous Waste Invest �azMat Pipeline Invest <br /> Cher Lead Agency SiteAgency: �RWQCB DTSC EPA L Site ater Quality Site Cher Type Site <br /> DESIGNATED EMPLOYEE # � -2 t PROGRAM ELEMENT # Z 9 S Q CURRENT STATUS <br /> NUMBER OF UNITS : EPA ID #: INSPECTION CCDE <br /> Number of TANKS Linked to this PROGRAM record : —0— <br /> BILLING ACKNOWLEDGEMENT: 1 the undersigned owner, operator or agent of same, acknowledge that all site and/or project specific <br /> PHS-EHD hourly charges associated with this facility or activity will be billed to the party idencified as the BILLING PARTY on <br /> the Masterfile Record Information Form. <br /> I also certify that I have prepared this application and that the work to be performed will be done in accordance with all SAN <br /> JOAQUIN COUNTY Ordinance Codes and Standards, State and Federal laws. <br /> APPLICAN'T'S SIGNATURE Donald E. Reed for Bright Development) <br /> Title: Vice President/General Manager Date: November 5, 1999 <br /> AUTHORIZATION TO RELEASE INFORMATION: In addition to the above, when applicable, I, the owner, operator or agent of same, of <br /> the property located at the above site address hereby authorize the release of any and all results, geotechnical data and/or <br /> environmental/site assessment information to SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION as soon as <br /> it is available and at the same time it is provided to me or my representative. <br /> DEADLINE DATES: Inspection: Current / Prior <br /> Fee Amount Amount ?aid Date of Payment Payment Type Receipt # `"heck # Recvd By <br /> 23 .00 52,7"(. 00 <br />