Laserfiche WebLink
APPLICATION FORM FOR UNION PACIFIC RAILROAD COMPANY <br /> ENVIRONMENTAL RIGHT OF ENTRY AGREEMENT <br /> Please,fill in as indicated. Please type or print clearly in all capital letters: <br /> RESPONSIBLE PARTYLICENSEE:_ <br /> Company Name Ground Zero Analysis, Inc. <br /> P O Box&Street Address 1714 Main Street <br /> City,State,Zip Code E s c a l o n, CA 95320 <br /> State of Incorporation CA <br /> Contact:(Name/Title) Greg Stahl , Vice President <br /> (Phone/Fax) (209) 838-9888 FAX ( 209 ) 838-9883 <br /> (email,ifpossible) gstahl@groundzeroanalysis .com <br /> LICENSEE CONSULTANT(if applicable): <br /> Company Name <br /> P 0 Box&Street Address <br /> City,State,Zip Code <br /> Contact:(Name/Title) <br /> (Phone/Fax) <br /> (email,if possible) <br /> SITE LOCATION(include City/County/State) Stockton, San Joaquin County, CA <br /> RAILROAD MILEPOST AND SUBDIVISION 0087,80,Stockton, DOT 752775G <br /> (or DOT Crossing Number on nearest railroad/street crossing <br /> LATITUDE AND LONGITUDE(degreeshninutes/seconds) 3 7? 5 4- 2 7"N, 121 16 - 2 7"W <br /> ADVISE THE NAME,ADDRESS,&CONTACT PERSON OF THE GOVERNMENTAL AGENCY <br /> REQUIRING THIS PROJECT: <br /> CA Regional WatserQuality Control Board, 11020 Sun Center Dr. ,Ste 200 <br /> Rancho Cordova, CA 95670, Gerald Djuth, Project Manager <br /> ( 916) 464-4677 <br /> Please describe your proposed project: <br /> PROJECT LEVEL(S): <br /> PHASE I(Non-invasive&non-intrusive visual site inspection and records check only. <br /> No sampling will be involved.) <br /> X PHASE II(Site investigation.You must advise specific testing to be performed from the <br /> list on the next page.) <br /> PHASE III(Site remediation.) <br /> OTHER(Please describe your project in detail only as it pertains to railroad property) <br /> TERM:DATES <br /> From:1 Day 3Mp (Includes removal/lawful closure of facilities and/or monitoring wells) <br />