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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> DATE 8!8/2013 11 MASTER FILE RECORD INFORMATION "FAFR" GREEN FORM <br /> swvenR13IS 5� •� Z� SITE MITIGATION &LOP <br /> OMER IDN UN{ - IN <br /> 01'.NCRFILE;COMPLETE PROPFRTYOWNENRESPONSIBLE PARTY INFORMATION: C/rcrx,FvwxEarscusarrrTLrotlFrtetrTrnE11O � <br /> PRopOWOYINERNAW Jon - _ Cram I' _ ( ) 805 92-5 $ 207 <br /> Managingr FIRS Mf U.sr PHONENumER <br /> IStlyNFgy NAatE T E-"L AOORM <br /> Sailta-Maria Investment LLC _ <br /> a,wER Hot+EADDRE8O <br /> Property ss1505 Na-v_y_Dz_ RtA <br /> Crlr STATE IJP <br /> stankunn Ca Ca. 93458 <br /> O'MIIER&tkvw hmneBs <br /> P.O. Box 5819 <br /> /UNJtiOADDRMCrtY STATE 7JP <br /> SANTA Maria, Ca. <br /> ❑000POPIATION ❑INDIVIDUAL ❑PARTRERS111P ❑COVEFJIWHTAGr.HGY Rcepo)iBIME PATwf LLC. [Romut <br /> SITil rAlTIGATION_ENVIR014LIL14TAL ASSESSMENT X VOLUNTARY CLIANUP_WATER QUALITY It10 PIPrLINL INVESTIGATION_LOP <br /> FAtNu1Y1Di lNVrf ADcounTID PRA/ROA AssroNEDEtapLOYEe LEAnAorNOY:EHD RWQOB_DTBD._EPA_ <br /> 23 ; g 361Sze!S9 Sa k-� Y Y <br /> FACILITY FILE:COMPLETE 13 USINESS I SITE/PROJECT INFORMATION: <br /> IS THISANEWPROJFCTLOCATIONJQFREVIOU8LYREGULATEDBYTtIEFNARONMENTALHEALTHDEPARTMENT? YEa ® No ❑ <br /> 19 TH19 AN EXISTING PROJEOT LOOATION,BUT ANEW SOOPE Of WORK? Yea ❑ No$j <br /> OUBME&WAGlfrYl$[rrJPROJF&TtikK Vernon Trans lUr(Mio l <br /> 61TE ADORE"I PROJECT LOCATION 1505 Nary Drive BtATEA BU9rNETi3PNONE <br /> CITY Stockton FTTATE zip, <br /> CA 95206 <br /> BOARD Of SUPPRVMOR DISTOIOT J LOCAT"CDDE Q / KtY1 KEY2 <br /> IAA u"o ADDPJM,IFUr,FEREUT FROM FACYTTY ADDRm ATTEHI)ON:ORCARE OF(O ) -- <br /> NIAnlNGADDRE"CrtY STATE XTP IIIOcDDE APNi CO MENT: <br /> T1i IRO PARTY B ILLINO INFO:COMPLETE IF BILLING PARTY IS DIFFERENT FROM PROPERTY OWNER OR RESPONBtBLC PARTY IDENTIFIED ABOVE. <br /> 13MUE68NAI- Partner C-ngineering and Science,Inc. AYTCMOI:OROARCOF(OPTIOANI) Samantha Harris <br /> 1A111LINOADDRM 2154 Torrance Boulevard,Suite 200 PHONE <br /> 310-765-7258 <br /> OtTY Torrance _. BTATr('n zip 90501 <br /> ADOouHTAuousaToBE140FEES AND CHAROEo: OWNER❑ F=UTYIBV9RIESSN THIRDPARTYBILLWO❑ <br /> 7aLTNC trs ColrPS]MC1 ACf�0117 FSG?rPlTrt I,the tmdennl,"fitry that I am tba On for,&Aorirtd Agt J?"4fbla Pmfy and I►c[muRltdga that aU PMnTFW, <br /> PzwTr>;S,EhT0xrV9TCWGUand/or IIOURLYCfafR ascotletcdnllhlhlrprul"tn111btbAledtoweolehe.c reu denflrwdaboVeellheACMUNTADD9Mrortbltelte. IAgocertifyll.lal] <br /> Inromst)nn prof idtd on thh Applkatiaa[I trot and corretll sad that all rtgv4lyd a clhillts will be perrormed In accordance nilb AR applicable SAN JatQinY COUNTY ORMUNCE COPYZ Aad/or <br /> STANDARDS And$TATE.acd/orFEDERALLab axml WMATIONS. Aa the a,0trslgnulpnrrrr,O/armor,AudkorttcdA8e 1ptVRrrywxstbleA7rVrarthe project lots"xbtwcunder farUityhNeaddrets,I <br /> hrrtby autborize lit rticstc of Any and All rteulN reports,and athtr tAdronmenld u:tismtnt InformMlm 10 SAN JOAQtR:m CQUTt Y Eh Rn }ITAI,TIID€PAYrAiYNT at somas 116 AvAllable <br /> and.Ithe Prue lime 11III prmldedmaeamyrepratcWhr. <br /> APPL"Hr NAME(PLEABEPRINr) Samantha llmris 131pFTATVRE <br /> Tnu Project Manaser TAk OM 20.8264379 <br /> Ar"WM BY DATE Ao Mrlri MO Orirq[PRotalsz oC*kFW,A BY <br /> BrtEMIMTION AYOUNTPAID DATEOFPAYMFM pAYYEHTTYPE ACOEIPTM CHECNA RECFIVfOBY ORKPIgsIPLe <br /> 8_I�-f 2 L7/-/&f Gj �L( I /_1yGtrv7Ea2 <br />