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X ENVIRONMENTAL <br />ASSESSMENT <br />2950 <br />EHD LOCAL VOLUNTARY <br />CLEANUP <br />2953 <br />Li RWQCB LEAD- <br />CORRECTIVE ACTION <br />2960/3526/3527 <br />[11 RWQCB LEAD- <br />WATER QUALITY (WDR) <br />2965 <br />Li DISC LEAD <br />2959 <br />Li FED EPA LEAD <br />2954 <br /> <br />SAN JOAuUIN COUNTY ENVIRONMENTAL HEALTH D... ,RTMENT <br />SITE MITIGATION MASTER FILE RECORD INFORMATION FO RIVE, vcit'D <br />"MFR"- GREEN FORM <br />DATE i MARCH 29, 2019 <br />T. <br />l "I VIAZL 2819S FOR EHD USE I V4t!op404 <br />OWNER FILE : COMPLETE PROPERTY OWNER/ RESPONSIBLE PARTY INFORMATION: CHECK IF OWNER 401Niivry4tiestfekv <br />Stip <br />EHD <br />BILL ABOUMRAD 510-744-3530 <br />YUCEL CELEBI 510.873-5932 <br />PROPERTY <br />OWNER NAME <br />1 <br />LAST <br />PHONE <br />Fins,- MI <br />NAME TRACY ALLIANCE GROUP LLC E-MAILUSINESS ADDRESS BABOUMRADE@LEGACYREA.COM <br />YUCELCELEBI@GMAILCOM <br />OWNER HOME ADDRESS ATTENTION: ORCARE OF (OPTIONAL) BILL ABOUMRAD <br />OR YUCEL CELEBI <br />CITY STATE ZiP <br />OWNER MAILING ADDRESS 41111 MISSION BOULEVARD <br />MAILING ADDRESS CITY STATE ZIP FREMONT, CA 94539 <br />CORPORATION <br /> <br />INDIVIDUAL <br />PARTNERSHIP <br /> <br />GOVERNMENT AGENCY (2 RESPONSIBLE PARTY <br /> <br />OTHER <br /> <br />FACILITY FILE: COMPLETE BUSINESS / SITE/ PROJECT INFORMATION: <br />IS THIS A NEW PROJECT LOCATION NOT PREVIOUSLY REGULATED BY THE ENVIRONMENTAL HEALTH DEPARTMENT? <br />IS THIS AN EXISTING PROJECT LOCATION, BUT A NEW SCOPE OF WORK? <br />YES 0 No' UNKNOWN <br />YES D No R UNKNOWN <br />BUSINESS/FACILITY/SITE/PROJECT NAME TRACY RIDGE 1 APN <br />213-170-27 <br />SITE ADDRESS/PROJECT LOCATION 6599 AND 6735 W. GRANT LINE ROAD BUSINESS PHONE <br />CITY TRACY. CA STATE ZIP <br />r <br />BOARD OF SUPERVISOR DISTRICT 1 LOCATION CODE 11 KEY1 j Ker2 <br />MAILING ADDRESS , IF DIFFERENT FROM FACILITY ADDRESS <br />MAILING ADDRESS CITY STATE ZIP <br />SIC CODE COMMENT: <br />REOUESTOR'S INFORMATION: <br />BUSINESS NAME TERRACON CONSULTANTS INC ATTENTION TONY MIKACICH / TAMARA WOODS <br />MAILING ADDRESS 902 INDUSTRIAL WAY PHONE 209-367-3701 <br />Cm( LODI CA 95240 STATE ZIP EMAIL <br />ACCOUNT ADDRESS To SEND FEES AND CHARGES: OWNERO FACILITY/BUSINESSO REQUESTOFX <br />BILLING AND COMPLIANCE ACKNOWLEDGMENT: 1, the undersigned Applicant, certify that I 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 ORDLNANCE 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 il ls available and at the same time it is provided to me or my representative. <br />APPLICANT NAME (PLEASE PRINT) TERRACON CONSULTANTS INC <br /> SIGNATURE %-,7141/ta,t1-4- <br />TITLE <br />ENVIRONMENTAL CONSULTANT <br /> TAX ID # <br /> <br />1 FA #: 14ob2.S-1 33 OWNER iD #: !DitiO02.33-6- ACCOUNT #: /kozz--y,/,„--7f7,2 <br />ASSIGNED TO: <br />PR 0: --Fi.4_,)741.1-, 3 0 <br />ACCOUNTING COMPLETED BY: / q #X <br />DATE: 3 1 0 <br />SR TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE SERVICE REQUEST# INVOICE# <br />Work Plan 2903 <br />2904 <br />523 <br />523 <br />$456.00 <br />$760.00 $7 ki,S10 vA103 L --)4 ‘4,13 L 1,1 sv-ooft0L+ I <br />Site Mitigation MFR 2-26-2018