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SAN JOA \I COUNTY ENVIRONMENTAL HEALTH D \ RTMENT <br />SITE MITIGAu ION MASTER FILE RECORD INFORIltir, 110N FORM <br />"MFR"- GREEN FORM <br />DATE October 3, 2018 SHADED AREAS FOR EHD USE <br />OWNER FILE : COMPLETE PROPERTY OWNER/ RESPONSIBLE PARTY INFORMATION: CHECK IF OWNER IS CURRENTLY ON FILE WITH EHD <br />PROPERTY <br />OWNER NAME <br />PHONE <br />FIRST MI LAST <br />BUSINESS NAME Diamond Foods, LLC. E-MAIL ADDRESS <br />OWNER HOME ADDRESS ATTENTION: ORCARE OF (0P770NAL) <br />CRY STATE ZIP <br />OWNER MAILING ADDRESS 1050 S. Diamond St. <br />MAILING ADDRESS CITY Stockton, CA 95205 STATE ZIP <br />IX CORPORATION INDIVIDUAL PARTNERSHIP <br /> <br />El GOVERNMENT AGENCY El RESPONSIBLE PARTY <br />OTHER <br />ENVIRONMENTAL EHD LOCAL VOLUNTARY GI RWQCB LEAD - RWQCB LEAD - <br />ASSESSMENT <br />2950 <br />CLEANUP <br />2953 <br />CORRECTIVE ACTION <br />2960/3526/3527 <br />WATER QUALITY (WDR) <br />2965 <br />DTSC LEAD FED EPA LEAD <br />2959 2954 <br />FACILITY FILE: COMPLETE BUSINESS! SITE/ PROJECT INFORMATION: <br />I NEW PROJECT LOCATION NOT PREVIOUSLY REGULATED <br />I EXISTING PROJECT LOCATION, NEW SCOPE OF WORK? <br />ENVIRONMENTAL HEALTH DEPARTMENT? YES . No li <br />YES Ig4 NO III <br />BUSINESS/FACILRY/SITE/PROJECT NAME Diamond Foods APN 155-320-190 <br />SITE ADDRESS / PROJECT LOCATION 1050 S. Diamond St. BUSINESS PHONE (209) 951-2188 <br />Orr( Stockton, CA 95205 STATE ZIP <br />BOARD OF SUPERVISOR DISTRICT 1 LOCATION CODE Keil KEY2 <br />MAILING ADDRESS, IF DIFFERENT FROM FACILITY ADDRESS <br />MAILING ADDRESS CRY STATE ZIP <br />SIC CODE Colman% <br />REQUESTOR'S INFORMATION: <br />BUSINESS NAME ATC Group Services LLC ATTENTION Jeanne Homsey <br />MAIUNG ADDRESS 1117 Lone Palm Avenue, Suite 201B PHONE (209) 579-2221 <br />C" Modesto STATEcA ZIP 95351 E"-jeanne.homsey@atcgs.corr <br />ACCOUNT ADDRESS TO SEND FEES AND CHARGES: OwNERE <br /> <br />FAciLiTy/BuSINESSO <br /> <br />REQUESTORD <br />BILLING AND COMPLIANCE ACKNOWLEDGMENT: I, the undersigned Applicant, certify that! am the Owner, Operator, Authorized Agent, <br />or Responsible Party and I acknowledge that all PERMIT FEES, PENALTIES, ENFORCEMENT CHARGES and/or HOURLY CHARGES associated <br />with this project will be billed to me at the address identified above as the ACCOUNT ADDRESS for this site. I also certify that all <br />information provided on this application is true and correct; and that all regulated activities will be performed in accordance with all <br />applicable SAN JOAQUIN COUNTY ORDINANCE CODES and/or STANDARDS and STATE and/or FEDERAL Laws and REGULATIONS. As the <br />undersigned Owner, Operator, Authorized Agent, or Responsible Party for the project located above under facility/site address, I hereby <br />authorize the release of any and all results, reports, and other environmental assessment information to SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT as soon as it is available and at the same time it is provided to me or y representative. <br />k, <br />FA #: F- OWNER ID #: 6 iv 00,2,33r7:1 ACCOUNT #: Ake:0 %752r ASSIGNED TO: <br />PR #: pkasIts83.2 ACCOUNTING COMPLETED BY: a DATE: iqs- jg- <br />SR TYPE PE Sc FEE INFO AMT REMITTED CHECK# REM) BY DATE SERVICE REQUEST# INVOICE# <br />Work Plan 2903 <br />2904 <br />523 <br />523 $760.00 CI L-15-6 <br />$456.00 <br />itiqUI L—X IOW los sr—eu19lt.03 <br />APPLICANT NAME (PLEASE PRINT) <br /> <br />IgYka___ <br />TITLE --&-cuAcin INkotw I Con so (--tia i4± <br />SIGNATURE <br />TAx Wit <br /> <br />Site Mitigation MFR 2-26-2018