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2900 - Site Mitigation Program
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PR0506710
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Last modified
3/13/2020 12:54:36 PM
Creation date
3/13/2020 11:02:48 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0506710
PE
2950
FACILITY_ID
FA0007592
FACILITY_NAME
FRIENDLY CHEVROLET
STREET_NUMBER
2996
Direction
S
STREET_NAME
MCHENRY
STREET_TYPE
AVE
City
ESCALON
Zip
95320
CURRENT_STATUS
01
SITE_LOCATION
2996 S MCHENRY AVE
P_LOCATION
06
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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SAN JOAQUIN COUNTY PUBLIC HEALTH SERWII-ES <br /> ENVIRONMENTAL HEALTH DIVISION PAYMENT <br /> P.O. BOX 3M 304 EAST WESE'r AVENUE, STOCKTON, CA 95201RftE'VE® <br /> (209j 46YJ420 <br /> XON-REMDA 8tt PERMR JUN 0 6 1997 <br /> AFRJCATAN 161NR BY MADE TO THE SAR JOAO COUNTY FOR A PERMIT TO CONSTRIXT AFICIMR INSTAU.THE WOAR DESCRIBED.THIS ICATION 19 MADE IN COSOVANCE WIT"SAI <br /> JOAOVM COONrY pEVELOPMEM TITRE,CNAPTFR 9-111 S.3 IBD TME 6TANOAI108 OF#AN AAWIN CDVHTY NSUC HEALTN GE-T4VI/CEG,E��N [NO��I1g8N�N17. n <br /> 'E 776 !- TT1 G 14 Z-0 /V FWRONM&AW�E%uzmDWIjQfN_It��L�/ <br /> .)06 ADDRl6alOR AP"I � [ [[O „J(Ju/`/ r�� HC N�� 14v, <br /> /V CRY <br /> Owi1ERa NAME��n/�.1C�/U�R FTA{(��f(J(r}/ d AF Pi AjH�lG�aS G� aa� �1,ISk IT�tIJIUp' /R.l� lY,�l7(�ESTCbHON£.'�YT�7 ��7 <br /> COMRAROR_�/L1 IAW/�'1/C-♦' I C— <br /> MRI <br /> - .IDCNEGG //I /'SOA/ l/G UC1 P110NE/%,G PSL/6/!� <br /> CONTRAC �/TOR /ky/V�/-- AOORE5.23762 ., 1 Z�PNON£,�MQ F ' <br /> T,N!O/M'EL1lYVYP, ❑ NEW WFll ❑ RERACEMENT WEIl ❑ MOMIONNIO WE,l, ❑ OrHEN I <br /> ❑ INSTAWTION ❑ WELL SYSTEM REPAIR ❑ CIMOSLtONHECT REPMR ❑ VAFEIR EXTRACTLON WELL F J <br /> ❑Mery❑Rwwr HP. miITM NMP 9ET___FT. RRSr WATER UVEL O <br /> TYPE OF NMPI <br /> G ovroaaEnvni WILL ❑ DEDF. mcx wEu+ SOIL 9oRNo 9 <br /> ❑oE9rwATlo.r. ' <br /> I <br /> INTERoFD USE TYK OF WM VC ATIONS A <br /> ❑IIId18TTSAL ❑OPEN BOTTOM p1A.Of WEU MAVATMN OM,OF CONDUCTOR CASINO D <br /> ❑ DOMESIICTTSVATE ❑III���OMVEL PAcx=c TYPE OR CASINOnTTEENPYC OIA.OF WEU CAGMO O <br /> ❑ PAUCAMUNKIPAL fy OMAN DEPTH OF OROVT bEN SKCAICATION R <br /> ❑ <br /> 1I —RI <br /> El OTHER OROVT CEAL INST.LL1ID BY OAOVT BRAND NwME E <br /> 14MONITORINGamw r✓<AL NMPEO: ❑Yr ❑W LbNcta;TT:PEOESTK BY DRIEER❑Y. ❑Ne 5 <br /> l <br /> AIVRO;.OE>TN 7_D LOCTUNO CHESTER wxL ow PBI p, S <br /> PROMSW CDM.TRU MON/ WNEO METHOD; MVD ROTARY 'AIR ROTARY AUGER. CABLE OTHER/ <br /> 1 NEI ESy C IFY THAT 1 HAVE PREPARED THIS APMICATIOH. THAT THE MOTK WEl BE OOHE IN KCOROf MTM SAN AAOUw COVNTY OROINANCEG.STATE ILA 9.AND RVLES AM <br /> MOVIATR)NS OF THE SAH JOAWM COMRTY. HOME OWNER OR UC£NaEO AGENTS WOFIANRE CERTIFIES THE FOLLOWDIa: 'I CERTIFY THAT W THE RMOAMANCE OF THE YAM FOR W"tcI � <br />� TISB IITWrtIe ISBUED,I91NAl1 NOT EM0.0Y POIBONe.U61ECT TO WORAAAN'S COMPdSAT10N VWSOF C11tfORMA' CONTIV.CLOT'BMION00R 6UBLOHTALTWOagMwNPE CEATiFlEt <br /> THE FOU.OWIW: -1 CERTIFY THAT M THIS KA%I MAACE OF THE WDM NOR WMItlM THIS"EAST 19 RSUED.1 SNAEL EMPLOY PERfON#SUBJECT TO WORgMAR'.COMPpMTMN f W§01 <br /> CAUFORMA.• T AIR1C�''MUS CALL NgUlt.M AWAMC'E FOR N M<RA ED MSrRCT10W AT ISen 490 Y=. COMPLETE DRAWING AT LOWER MFA PROVIDEO. <br /> j ROT PVN 4N.1.BJ.1 <br /> I. xAKa OF STREETS OR MO NEAREST TO OR WUNOINO THE F`MPERTY. e. LOCATION Of HOUSE BEWAGE OHIM9Al SYSTEM OR PROPOSEO 1 <br /> S. d UNE Of THE PROPEFRY.O DIMENSIONS ANO NORTH DIPECTWN. EXPAHMN OF SEWAGE OISMGA&SYSTEMS. . <br /> O, gMWLIOMD O VrUNF,R AND LOCATION Of ALL ETPaRNb ANO PROPOSED G. LOCATION OF WELL#W HIH RADIUS OF ONE HUNDRED FRTY IT.; <br /> 9iRWTLRR5.MCLUC"A MVEFED AW SUCH AS PATHS.ORVEWAYS,ANI WAIXS. ON THE PROPER"OR AOJOIMHO PIOPFRTY. <br /> .'. .. :..... AAAA ' . :./'� ..� .' _ ... AAAA.AAAA.. ... <br /> G <br /> ... AAAA. AAAA. i. _ AAAA <br /> MAP ON BACK <br /> ... <br /> A , . <br /> IL <br /> AT *06b IN 04h - WvT- I ......: L `. .ud .. <br /> OfTARTMCET USE ONLY " Y <br /> A�IIM,Awgl.a Br �� _ DMe�I IDjV SIT Mr <br /> o..M IA�.m,NA,w_/ � D«. I.•:11 �h/1___P••I.P I,w�Ile.,BY D•,• <br /> D�U�ucllR,Ns..al�. <br /> BY o.I. . <br /> I <br /> c <br /> A"u"MRO ONLY: AID. FAC, <br /> IR cools REIFSC FRIOVNT FD CNECR82RSN RECBVm BY OAT[ ry3PRTISgVICF RCOUFIT NWSOR O#VOICE <br /> o <br /> 1 <br />
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