My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
BILLING
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
R
>
ROUGH & READY ISLAND
>
0
>
2900 - Site Mitigation Program
>
PR0524308
>
BILLING
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
5/19/2020 1:41:49 PM
Creation date
5/19/2020 1:41:03 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
BILLING
RECORD_ID
PR0524308
PE
2954
FACILITY_ID
FA0016302
FACILITY_NAME
PORT WEST COMPLEX
STREET_NUMBER
0
STREET_NAME
ROUGH & READY ISLAND
City
STOCKTON
Zip
95203
CURRENT_STATUS
01
SITE_LOCATION
ROUGH & READY ISLAND
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
TSok
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
2
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> SITE MITIGATION MASTERFILE RECORD FORM <br /> GENERAL PROGRAM FILE: New Change Edit (PROG4) revised 5/23/94 <br /> FACILITY ID # O p 4r,3 c),-'- FACILITY NAME f ��C4i( (c" <br /> RECORD ID # s �OF PRIOR DIST # PRIOR SWEEPS # <br /> ite Mitigation: x Environmental Assessment ST/CAP cal Hazardous waste Invest �azMat Pipeline Invest <br /> Other Lead Agency SiteAgency: I IRWQCB <br /> DISC EPA kL Siteater Quality Site Other Type Site <br /> DESIGNATED EMPLOYEE # L� PROGRAM ELEMENT # '-L'q SW CURRENT STATUS <br /> NUMBER OF UNITS EPA ID #: INSPECTION CODE <br /> Number of TANKS linked to this PROGRAM record <br /> BILLING ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site and/or project specific <br /> PHS-EHD hourly charges associated with this facility or activity will be billed to the party identified as the BILLING PARTY on <br /> the Masterfile Record Information Form. <br /> I also certify that I have prepared this application and that the work to be performed will be done in accordance with all SAN <br /> JOAQUIN COUNTY Ordinance Codes and Standards, State and Federal laws. <br /> APPLICANT'S SIGNATURE <br /> Title: Date: <br /> AUTHORIZATION TO RELEASE INFORMATION: In addition to the above, when applicable, I, the owner, operator or agent of same, of <br /> the property located at the above site address hereby authorize the release of any and all results, geotechnical data and/or <br /> environmental/site assessment information to SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION as soon as <br /> it is available and at the same time it is provided to me or my representative. <br /> DEADLINE DATES: Inspection: Current / / Prior <br /> Fee Amount Amount Paid Date of Payment Payment Type Receipt # Check # Recvd By <br /> WS7v3- <br />
The URL can be used to link to this page
Your browser does not support the video tag.