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SITE INFORMATION AND CORRESPONDENCE_FILE 1
EnvironmentalHealth
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2900 - Site Mitigation Program
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PR0540885
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SITE INFORMATION AND CORRESPONDENCE_FILE 1
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Last modified
4/10/2020 9:19:48 AM
Creation date
4/10/2020 8:44:31 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
FileName_PostFix
FILE 1
RECORD_ID
PR0540885
PE
2960
FACILITY_ID
FA0023381
FACILITY_NAME
FORMER EXXON SERVICE STATION NO 73942
STREET_NUMBER
4444
Direction
N
STREET_NAME
PERSHING
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
11022017
CURRENT_STATUS
01
SITE_LOCATION
4444 N PERSHING AVE
P_LOCATION
01
QC Status
Approved
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EHD - Public
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PAID tui (copy Irom item one <br /> I.." <br /> It other lnformatlon(Optional) r0 osed facility. <br /> Use the space below to expand upon any <br /> of the above questions or tebmii f3 to <br /> forothef PheP evlewer an <br /> other information you feel should be considered in establishing P <br /> Attach additional sheets it necessary. <br /> Credits are requested for the six metals listed in Section V (Group g) because they <br /> roundwater being extracted. <br /> naturally are present in the g <br /> 111.certification <br /> I certify under penalty of law that this document and all attachme7npage <br /> ed under my direction or <br /> evaluate supervisionin <br /> n acc accordance <br /> e w submitted. Based onsmy inquiry of the perrsigned to assure that hfied perso, o menagennel rthe best of my <br /> system, o� <br /> rmation, th <br /> those pknowleersons dge ndbeliefrt ue,eccurateresponsible �andcompleter gathering .lamoawarethattnttion ipenahes/otted is, to rsubmitting <br /> false information, including the possibility of fine and imprisonmentlations. Phone No <br /> Name and oli,oal Tolle(t YPe or pant/ <br /> 713 <br /> K R. T. Harvin, Real Estate ii <br /> En ineerin Ma na ero nate S-gned <br /> Signature a ��L'��/ <br /> K Page 5 of S <br /> EPA'Form 3510 20 t9-86) <br />
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