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SITE INFORMATION AND CORRESPONDENCE
EnvironmentalHealth
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2900 - Site Mitigation Program
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PR0004367
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
5/7/2020 4:05:33 PM
Creation date
5/7/2020 3:46:56 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0004367
PE
2951
FACILITY_ID
FA0004052
FACILITY_NAME
FARM UGT
STREET_NUMBER
18775
Direction
S
STREET_NAME
TOM PAINE
STREET_TYPE
RD
City
TRACY
Zip
95376
APN
21302030
CURRENT_STATUS
02
SITE_LOCATION
18775 S TOM PAINE RD
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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L.J <br /> Michael J. infurna Jr. San Joaquin County <br /> Senior RENS <br /> Public Health <br /> Site Mitigation Unit IV 1 LOP <br /> Fifth Floor .Environmental Health <br /> 04 E. Weber St. 3ra <br /> (209) 468-3454 Stockton, CA., 95202 <br /> fax: (209) 468-3433 <br /> F6. ED <br /> Fax 3f10 <br /> From: MICHAEL INFURNA, REHS <br /> To: JOHN P CUMMINGS CONSULTING <br /> Fax #: 510-791-3306 <br /> Pages: <br /> .,Z-# <br /> Phone: <br /> Date: August 23, 1999 <br /> Re: NEW BORING PERMIT APPLICATION & BACK PAGE (LCD) <br /> ❑ Urgent ❑ For Review ❑ Please Comment <br /> • Comments: HERE ARE THE NEW FORMS WE ARE USING FOR PERMITS. <br /> YOU MAY SAVE THEM AS MASTERS AND REPRODUCE THEM AS YOU <br /> NEED. IF THE CONSULTANT SIGNS THE APPLICATION, AN <br /> "AUTHORIZATION TO SIGN" LETTER IS REQUIRED FROM THE C-57. THE <br /> C-57 MUST SIGN THE "LICENSED CONTRACTOR DECLARATION" (LCD), <br /> AND THE "AUTHORIZATION TO SIGN". THE CONSULTANT OR THE C-57 <br /> CONTRACTOR CAN FAX THE SIGNED FORMS TO PHS-EHD. PROCESSING <br /> THE PERMIT CAN ONLY OCCUR AFTER THE FEE IS RECEIVED AT PHS-EHD. <br /> STATEMENT OF CONFIDENTIALITY: The information in this facsimile is legally privileged and confidential information intended <br /> only for the use of the addressee listed on this cover sheet. If the reader of this message is not the intended recipient, or the <br /> employee or agent responsible to deliver it to the intended recipient,you are hereby notified that any dissemination,distribution or <br /> copying of this telecopy is strictly prohibited. If you have received this facsimile in error,please immediately notify us by telephone <br /> at the number listed on this cover sheet and return the original message to us at the above address via United States Postal <br /> Service. We will reimburse your costs in notifying us and returning the message to us. Thank You. <br /> �Y <br />
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