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FIELD DOCUMENTS
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EHD Program Facility Records by Street Name
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2900 - Site Mitigation Program
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PR0516350
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Last modified
5/8/2020 12:28:58 PM
Creation date
5/8/2020 12:00:11 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0516350
PE
2950
FACILITY_ID
FA0012574
FACILITY_NAME
LEWIS MANOR - MUNI MW (4)
STREET_NUMBER
902
Direction
W
STREET_NAME
12TH
STREET_TYPE
ST
City
TRACY
Zip
95376
APN
23229069
CURRENT_STATUS
02
SITE_LOCATION
902 W 12TH ST
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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Michael J. infurna�'. r. <br /> Senior REHS San Joaquin <br /> Site Mitigation Unit IV 1 LOP PublicHealth Services, <br /> Fifth Floor Environmental <br /> 304 E. Weber ' <br /> (209) 468-3454 <br /> Stockton, CA., 95202 <br /> fax: (209) 468-3433 <br /> FcAax <br /> From. MICHAEL INFURNA, REHS <br /> o: Fax #: -5� -6 <br /> Pages: Phone: <br /> Date: 7-1-5 .Cx, Re: PAPERWORK FOR DRILLING AT NEW SITE <br /> ❑ Urgent For Review❑ Please Comment❑ Please Reply❑ Please Recycle <br /> • Comments: IN ORDER TO ISSUE A BORING PERMIT FOR THE WORK YOU ARE <br /> PROPOSING, THE FOLLOWING PAPERS WILL. NEED TO BE COMPLETED, SIGNED, AND <br /> RETURNED TO PHS-EHD FOR REVIEW AND APPROVAL: <br /> 1. A WORK PLAN,COMPLETE WITH THE PHASE 1 INFORMATION, <br /> 2. THE"GREEN-MFR"FORM PLUS A SEPARATE CHECK FOR$234 MADE OUT TO PHS-EHD, <br /> 3. A BORING PERMIT APPLICATION FOR EACH PARCEL AND MATCHING$89 CHECK EACH, <br /> 4_ ANY CITY OR COUNTY ENCROACHMENT PERMrrS"OR PRIVATE PROPERTY ACCESS <br /> AGGREEMENTS. DO NOT SCHEDULE ANY DRILLING DATE UNTIL A PHS-EHD STAFF <br /> MEMBER ADVISES YOU THAT THE PERNIMS)HAVE BEEN ISSUED. <br /> STATEMENT OF CONFIDENMI.1TY: The information in this facsimile is legally privileged and confidential information <br /> intended only far the use of the addressee listed on this cover sheet: ff the reader of this message is not the intended <br /> recipient,or the employee or agent responsible to deliver it to the intended recipient,you are hereby notified that any <br /> dissemination,distribution or copying of this telecopy is strictly prohibited. if you have received this facsimile in emror, <br /> please immediately notify us by telephone at the number listed on this cover sheet and refs=the original message to <br /> us at the above address via United States Postal Service: We will reimburse your costs in notifying us and returning the <br /> message to us. Thank You <br /> t l fig"' <br /> r <br />
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