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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> SITE REMEDIATION INFORMATION <br /> [SiteD: SDt�p��g Case ID: RO DaadSs� Existing FA <br /> Facilit ID• <br /> SITE INFORMATION <br /> Business Name: j7)5G Iv o4 E,f Phone: <br /> Street#• 1 �w c/ Dir: to Street Name: � Type: <br /> City: 5 � ti State: �► Zip: Z p3 <br /> County: 39—San Joaquin County APN: 14./,T_ <br /> CASE INFORMATION <br /> Program Element: I '�- � S C> Assigned Name: MAINSITE <br /> Regulatory Oversight Program: T(-/Zl <br /> Funding for Regulatory Oversight: <br /> Funding for Cleanup: <br /> File Location: L—Local Agency <br /> RISK MANAGEMENT <br /> ❑A-Drinking Water Supply Aquifer Affected ❑ F-Surface Water ❑ S-Soil Only <br /> Case Type: <br /> ❑ W-Drinking Water Well Affected �U-Undetermined Affected <br /> Beneficial Use: MUN—Municipal and Domestic Supply <br /> Vulnerability Basis: <br /> MTBE Threat Classification: MTBE Cleanup Classification: NA <br /> Number of Impacted Wells: 0 Well Impact Description: None G 2 Qt"'rNocvZ) <br /> CASE MANAGEMENT <br /> Brownfield: M N—Site is not part of Brownfield Site Management Requirements: NA—No Action <br /> Current Land Use: ❑ Agricultural 9 Coimnercial ❑ Industrial ❑Public Use ❑Residential <br /> Exclude from Export **Leave blank unless PE code is any 2900 sites.** <br /> Completed By: Date: / z�/ 3 <br /> Entered By: N Date: r7h, h <br /> EH-29- <br /> 09/18/2007 <br />