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SITE INFORMATION AND CORRESPONDENCE_FILE 1
EnvironmentalHealth
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2900 - Site Mitigation Program
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PR0528433
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SITE INFORMATION AND CORRESPONDENCE_FILE 1
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Last modified
4/3/2020 2:46:38 PM
Creation date
4/3/2020 2:30:39 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
FileName_PostFix
FILE 1
RECORD_ID
PR0528433
PE
2957
FACILITY_ID
FA0019174
FACILITY_NAME
CHEVRON SERVICE STATION 9-6171
STREET_NUMBER
6633
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
09741048
CURRENT_STATUS
02
SITE_LOCATION
6633 PACIFIC AVE
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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3 <br /> LETTER OF ACKNOWLEDGEMENT : All proposals and reports submitted must be <br /> accompanied by a cover letter from the responsible party ( ies) which states, <br /> at a minimum, the following : <br /> TO: SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES/ENVIRONMENTAL <br /> HEALTH DIVISION <br /> P. O. Box 2009 <br /> Stockton, CA 95201 <br /> FROM: <br /> c I (company name) /-/ n <br /> RE: �[G� �6vL 9 - (-"1� ( �c c0�� -Fac,T�! Av;E, S4ar-�—+ow <br /> (facility address) <br /> I (We) declare, under penalty of perjury, that the information and/or <br /> recommendations contained in the attached proposal or report is/are true <br /> and correct, and that all work and reports which required geologic or <br /> engineering evaluations and/or judgments have been performed under the <br /> direction of an appropriately registered or certified professional . <br /> The attached proposal or report utilizes the "Regional Board Staff <br /> Recommendations For Initial Evaluation and Investigation of Underground <br /> Tanks" and "Appendix A" reporting format. The LUFT Manual has also been <br /> utilized as a guidance document. <br /> Furthermore, I (We) agree to submit, on the date noted, the following on the <br /> sites) in question : <br /> 1 . Submit a Soil Contamination Work Plan and Soil Remediation <br /> Plan by (date) to San Joaquin County PHS/EHD. <br /> OR <br /> 2. Submit a Preliminary Report by (date) <br /> to the San Joaquin County PHS/EHD and the Central Valley <br /> Regional Water Quality Control Board (CVRWQCB) . <br /> signature and to 1 e ��V�ronw( c� i� r date <br />
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