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2900 - Site Mitigation Program
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PR0542364
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Last modified
5/4/2020 3:33:58 PM
Creation date
5/4/2020 2:59:30 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0542364
PE
2960
FACILITY_ID
FA0024340
FACILITY_NAME
PACIFIC CAR WASH
STREET_NUMBER
4405
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
11024014
CURRENT_STATUS
01
SITE_LOCATION
4405 PACIFIC AVE
P_LOCATION
01
QC Status
Approved
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EHD - Public
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PUBLIC HEALTH SERVICES co <br /> SAN JOAQUIN COUNIYJOO1 KHANNA M.D., M.P.11. <br /> H071111 off carP. O. Ilux 2009 . ( 1601 East Itazeltun Avenue) . Stockton, California 95201 �� � <br /> ( 209) 468. 34011 <br /> RE: CALIFORNIA LICENSED CONTRACTOR QUESTIONNAIRE <br /> In order to comply with State and Local Laws relative to contractor licensing and <br /> Workman 's Compensation Insurance requirements, we are asking that you provide this <br /> Department with the information requested below. Please answer all of the questions and <br /> return the original of this letter to Public I lealth Services Environmental flealth Division . <br /> Ron Valinoti, Director <br /> Environmental Health Division <br /> BUSINESS NAME TREATEK INC . <br /> BUSINESS ADDRESS 2701_ E . HAMMER LN 103CITYSTOCKTON ZIP 95210 <br /> BUSINESS TELEPHONE ( 1 ) ( 209 ) 472 - 2020 (2 ) <br /> OWNER # 1 OCCIDENTAL CHEMICAL CORP . OWNER #2 <br /> ADDRESS 2901 LONG ROAD , GRAND ADDRESS <br /> PHONE NO. ISLAND , NY PHONE NO. <br /> ( 716 ) 773 - 8661 <br /> CA., CONTRACTOR LICENSE NO . 599.a38 ISSUE DATE e 3 9oEXP DATE N/ A <br /> LICENSE CLASSIFICATION (A, B, C) A 1F "C" INDICATE SPECIALTY NOS._ <br /> W/HAZ SUBSTANCE REMOVAL 6 REMEDIAL A TION <br /> 1F "C-61 " CLASSIFICATION, INDICATE TYPE/S LIMITED SPECIALTY/IES <br /> ARE THE LICENSES LISTED ABOVE CURRENTLY ACTIVE AND IN GOOD <br /> STANDING ? YES x NO 1F YOU ARE SUBJECT TO WORICMAN 'S <br /> COMPENSATION LAWS OF CALIFORNIA, DO YOU CARRY WORKMAN 'S <br /> COMPENSATION INSURANCE? YESx NO_ <br /> IF YES, HAVE YOU FILED A CERTIFICATE OF INSURANCE Wrrf-i THIS <br /> DEPARTMENT? YES_ NO x IF YES, EXPIRATION DATE <br /> SIGNATURES <br /> TITLE PROJECT MANAGER <br /> DATE 10 / 15 / 91 <br /> 1:11 00 03 <br /> A Div ifion of S." Joaquin ('uwuy I le , lds ('m Stertor <br />
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