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San Joaquin County Environmental Health Department <br /> DATE 1/18/2011 MASTER FILE RECORD INFORMATION"MFR" GREEN FORM <br /> SITE MITIGATION&LOP <br /> tWA=AREAS POR EMD UM ONLY s��b� b UNIT IV <br /> - oltrtaa,slDe cAaass'�CSO bte b <br /> OWMERFILEsCOMPLETE7HEFOLLOW/NG PROPERTY OWNER INFORMATION: CmamArOWNER CuwxaNnrawruswrrNEND <br /> � <br /> P�o►prYOvltotrssNAaas scoI L �4�e-� c -� . <br /> Foal -4Ap Last PNONa Ntreset <br /> eai"'r"N""E CA Army National Guard <br /> OIMIar Nertte Address <br /> F, T. <br /> CRY .J 5• STAn Zip <br /> O"""*vAd*— 10620 Mather Blvd. <br /> Meilbta Addrern Clly Mather Sbwe CA ZIP 95655 <br /> CORPORATION INDIVIDUAL❑ PARTNERr/RP❑ FEO AGENCY 0 on.ER L] <br /> am Enum10N iTAfr AMwR r VoWMTAnv C1JlA w_WAlmn QUALM_Nov/1lSJl0 MfYNlfalA110N_LOP— <br /> FACILITY 10 r INVs ACCOUNT 10 PR N RO rAsa1pNED EMPLOYEE LEAD AOENcY:EHD_RWOC13—DTSC_EPA <br /> W�lOb� b <br /> FACILITY FILE COMPLETE THEFOLLOW/NG BUSINESS I FACILITY/SITE INFORwTloN: <br /> Is ttws a Naw BwMlese LDCATION not previously repllieled by the EWA RONmrNTAL HEALTH DEPARTMENT? YES LJ No © <br /> Is fts an Exwm Busirtaea LOCATION but a NEw TYPE of repil od Business? YES ❑ No 29 <br /> ettssNssslpAcurvIartsNAssa Army Air Support Facility C'4 Z69 9 3 S33 <br /> �'T`AOOAr's <br /> 2000 Stimson Rd. Surras sslrrleasfr►IONt <br /> Ilk <br /> CIT' Stockton, CA 95206 STA" ZIP <br /> r <br /> BOARD OFSUPERVISOR D16TRK;T LxAooNCUDE Item KEYZ <br /> MeaY+O Addrew MQ E/fEJYf'llaw fiaaly Adlalw AIYEMIeEK ttrr m Of/g1lnesi f <br /> No"M A.M—Clbr STATti ZIP <br /> SIC CCgF APN r <br /> 7MAR PARTY MdL"*M tlW*i Cwi �ti/f Daft isdifJorwTtfrwnPr ` Owflor tArFat:Nrt ator iOwLvl�rdat�ovo. <br /> SatNwNAra AtirtMwcsrCereof(.relay <br /> MealrgAtWrens — P11UNE — ----- <br /> Cm --.—.. V,ATa - ZIP <br /> ACCLVNrALQRE33for fees and ch"es OWNER AitLIrr+1Busir,ESS THIRD PAR T-YBILLINfi \V\■ <br /> BILunc A.ND COM► I INCL AcsLNow'L[DGMaZa: 1,test undersigned Applicant,certify that I as the Okvw.Operarr,or Ar harixe/Apeor of thle 111"osa,and 1 scesnowledge tW as P[LNf► <br /> PENALTtrs,ENrorcawrNTCrurcrs and/or Houm.r CmAaIcrs associated wkb ebb operation well be Wald to lir at the address Identified above to W,4ccgyyffA9n=for thN fete. I also«rdly t►at <br /> sec Information provided on this application is trse aced correct;sad that as regain"activides wall be performed is accordance with as applicable SAN JOAQUW Comm Ordinance Codes and/or <br /> Standards and STATE and/or FEDERAL Laws and Reguisd m As test undersigned owner,operator,or agent of The property located at LM above,facaky/site address,I bertby sntesorire less release of <br /> any and all results and eaviroansrstal assrsrmeu Iafsraosdoo to SAN JOAQUIN COUNTY ENVIRONMENTAL.HFAI TH nf►ARTMF.NT lie emo as it Is ava4dNe art N tilt same lisat it k <br /> prnvesltd lu meor Rp rrprruauli/r. 1{ <br /> APPLJCANTW <br /> JItEIPLaA"P^Wrj S(::,O rT • P 11,-/tq t) ShiNATORE <br /> TITLETAxIDR �,tl QC <br /> C0I`'1eLI�CIk (3l1A06i, Cln6 -= T{C (33i� 1 <br /> Approval By A-Ung0ff1oaoProc&vovvjCo PMtad By <br /> SITEMITWATION Ammeter YMODATlOrMRM <br /> YaT I PAvrENTTvPE RECEIPTr CNECKfi RECEIVEDoRtc <br /> By WPuNPE ` <br /> FEE'S <br />