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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DRTMENT SITE MITIGATION MASTER FILE RECORD INFORMATION FORM "MFR"-GREEN FORM DATE March 30,2017 SHADED AREAS FOR EHD USE OWNER FILE:COMPLETE PROPERTY OWNER/RESPONSIBLE PARTY INFORMATION: cHEOANFOIWYwxGta1PEMLrwFAEW77Y EHD El PROPERTY H.M Weinberg PHONE OWNERNAME MRST LAST 310-363-7 '75 BUSINE88 NAPE E�IAILADDREa9 Peloria Paradise Point LLC howard weinber law.la OWNERHOMEAODPASS 2775 Via Tejon, Suite 2B AT*E•NTIoN:ORCARE OF(OPra ) CITY Palos Verdes Estates STATE CA LP 90274 OWNER MAILING ADDRESS 2775 Via Tejon, Suite 26 Mmuao ADORE9a Cm Palos Verdes Estates BT"TE CA LP 90274 ❑CORPORATION ❑INDIVIDUAL ❑PARTNERSHIP ❑GOVERNmew AGENCY ❑ResP SME PARTY OTHeR LLC ❑ ENVIRONMENTAL ❑ EHD LOCAL VOLUNTARY RWQCB LEAD— ❑ RWQCB LEAD— [3 DISC LEAD ❑FED EPA LEAD ASSESSMENT CLEANUP CORRECTIVE ACTION WATER QUALRYIWDR) 2959 2954 2950 2953 2960/3526/3527 2965 FACILITY FILE:COMPLETE BUSINESS/SITE/PROJECT INFORMATION: IS THIS A NEW PROJECT LOCATION NOT PREVIOUSLY REGULATED BY THE ENVIRONMENTAL HEALTH DEPARTMENT? YES ❑ No ag IS THIS AN EXISTING PROJECT LOCATION,BUT A NEW SCOPE OF WORK? YES No ❑ BUSINE99IFACILRYISITFJPRO.IECT NAME Paradise Point Marina APN. SITE ADDRESS I PROJECT LOCATION 8095 Rio Blanco Road BUSINESS PHONE 209-952-1003 CITY Stockton STATE CA ZIP 95129 BOARD OF SUPERVISOII DIarIam LOCARoNCODE KEY1 KEY2 MAILING AOORESS,IF DIFFERENT FROM FACILITY ADDRESS MNUNOAnonsa CITY STATE ZIP SICCove COMMENT: THIRD PARTY BILLING INFO:COMPLETE IF BILLING PARTY IS DIFFERENT FROM PROPERTY OWNER OR RESPONSIBLE PARTY IDENTIFIED ABOVE. BUSINESS NAME Arm"m:ORCASE OF tOPTIOMLI MANUNOAOORe" PHONE CRY STATE ZIP ACCOUNTADDRESS TOSEND FEES AND CHARGES: OWNER[] FACILITY/BUSINESSIIX THIRD PARTY BILLING❑ BILLING AND COMPLIANCE ACKNOWLEDGMENT: I,the undersigned Applicant,certify that I am the Owner,Operator,Authorized Agent, or Responsible Party and I acknowledge that all PERMIT FEES,PENALTIES,ENFORCEMENT CHARGES and/or HOURLY CHARGES associated with this project will be billed to me at the address identified above as the ACCOUNTADDRESS for this site.I also certify that all information provided on this application is true and correct; and that all regulated activities will be performed in accordance with all applicable SAN JOAQUIN COUNTY ORDINANCE CODES and/or STANDARDS and STATE and/or FEDERAL Laws and REGULATIONS. As the undersigned Owner, Operator,Authorized Agent, or Responsible Party for the project located above under facility/site address, I hereby authorize the release of any and all results, reports, and other environmental assessment information to SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT as soon as it is available and at the same time it is provided to me or my repfesentative. APPUCANTNAME(PLEASEPMNT) Peloria Paradise Point LLC BIONATURE TITLE Howard Weinberg, Manager TAKIDf 46-3434584 FAS: OWNER ID IT: . ACCOUNT C ASSIGNED TO: PR S: ACCOUNTING COMPLETED W: DATE: 932015 Site Mitigation MFR 29-