Laserfiche WebLink
San Joaquin County Environmental Health Department <br /> DATE MASTER FILE RECORD INFORMATION"MFR" GREENFORM <br /> Nov 23,2010 SITE MITIGATION & LOP <br /> SHADEDAREA8 FOR ENO on ONLY OmEa IDS c—IT -5R,po6SID07 UNIT IV <br /> OWNER FILE:COMPLETE TNEFOLLOW/NG PROPERTY OWNER/NFORMA71DN: oxEGas owNER CuaRERrLYowfNFWnN END E) <br /> PItoIRR1Y OWNER"nate NA NA ( ) 210-283-2000 <br /> Ffal MI Lesf PHONENIINI ES <br /> BuaWEx NAME ENaALMOREx <br /> Tesoro Companies Inc <br /> Owner Home Address <br /> 3450 South 344th Way <br /> CRY STATE ZIP <br /> Auburn STATE <br /> 98001-5931 <br /> Owner Melling Acidness <br /> Mellhg Addrex City ateA ZIP <br /> coapoNAWN(a INONIDUAL❑ PARINERSNIP❑ FEOAOENOY❑ DfHEa C= <br /> SITE Mintoa' TIOFt_ENNRONMENTAL Ps MSMENT_VOLUNTARY CLEANUP_WATER QUALITY_NW PIPESJNR INVESTIGATION_LOP_—'�� <br /> FACILITYIDM INYR Accouir lD P ROM ASSIGNED EMPLOYEE LEAD AGENCY:EHD_RWQCB_DISC_EP, <br /> l( 227V-3 3(c, <br /> FACILITYFII.E COMPLETE 7NEFOLLOW/NG BUSINESS/FACILITY/SITE/NFORMAT/ON: <br /> Is this a NEW Business LOCATION not previously regulated by the ENvIRONMENTAL HEALTH DEPARTMENT? YES ❑ No D <br /> Is this an EXIST NG Business LOCATION but NEW TYPE of regulated Business? YES ❑ No (]' <br /> BUSwEsslFACLLmBnE NAME Tesoro Fuel Terminal <br /> SITE ADOnes Sums BUSINEae PHONE <br /> 3003 Navy Drive 209-466-8800 <br /> CRY STATE zip <br /> Stockton CA 95206 <br /> IFOARDGF —D:-T= <br /> Rf <br /> 3DPERV NICT LDCAnDx RODE KEPI KEY! <br /> Nothing Addrex TYDJFFERENTrrosn FaeNlysiddtes, Attention:arcane Of(owhlnal) <br /> Melling Address City STATE zip <br /> SICCODE APNM Coamenn: <br /> THIRD PARTY BILLING INFO: Complete if Billing Party is different from Property Owner or Facility Operator identified above. <br /> BuslrEas NAME Attention:co-Care Of (opU"t) <br /> Stantec Consulting Corporation Todd Brown <br /> Melling Address PHDNE <br /> 3017 Kilgore Road Ste 100 916-861-04 0 <br /> Cm Rancho Cordova CA 95670-6150 STATE zip <br /> AGC� for fees and Charges OWNER FACILITYIBUSINESS THIRD PARTY BILLING <br /> BILLING AND Co r IANCE ACKNOw EDGMENT: 1,the undersigned Applicant,rerHfy thal I am the Omsrr,Opensar,or Aurharissd Agan of this Business,and 1 achoowfeilge That dl PFFN/T Fres, <br /> PEN:atncs,En'rURtE-u[nTCx.uecs and/or NOUruI'CxeeGEs associated with this operation wi6 be billed to me suhe addtTss itlenlifred slaw as the A[ml'TrAooaets for fishable. 1 also cerdfy that <br /> all information provided on this Application is True end corecel;and that all regulated activities will be performed in accordance with all applicable SAN JOAQUIN COUNTY Ordinance Codes and/or <br /> Standards and STATE and/or FEDERAL Laws and Regulations. As the undersigned owner,operatan or agent ofthe Property located at the above facility/sin,address,)hereby authorize the release of <br /> any and all results and env ranowntal aasessmenl information to SAN JOAQUIN COU ' Y YYIRONMENTAL HEALTH DEPARTMENT as soon as it is available sad at the same fime it is <br /> provided to me or my representalhx. <br /> APPLICANT NAME(PLEASE PRINT( /a AJ <br /> n,_ D - •-IFS TAx ID# 1 <br /> TITLE <br /> FMI <br /> TIGATION AMOUNTPAID <br />