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RPPfNDI X: Z <br /> State Water Resources Control Board <br /> TMF Assessment Form <br /> ASSESSMENT TYPE: ❑ Financing Project ❑ New System ❑ Change of Ownership <br /> WATER SYSTEM CLASSIFICATION: ❑ Community Water System <br /> ❑ Nontransient Noncommunity Water System <br /> ® Transient Noncommunity (TNC) Water System <br /> You may be eligible to use the TNC EZ Form <br /> A. WATER SYSTEM INFORMATION <br /> Water System Name: 88 Market Water System <br /> Water System Number: CA <br /> Water System Physical Address: _21850 E Liberty Road <br /> City: Clements Zip:95227 <br /> County: San Joaquin <br /> Division of Drinking Water Office or Local Primacy Agency: San Joaquin County EH <br /> B. PERSON COMPLETING THIS TMF ASSESSMENT (*Required fields <br /> *Name: Sam Hedge *Signature:,—" <br /> *Title :WDO D1 *Date Assessment Completed:0312312020 <br /> *Phone Number: 209-406-6069 Email Address: samhedge@caldsl.net <br /> *Company Name and Address: 30,000 Kasson Road <br /> City:Tracy CA. Zip: 95304 <br /> C. MAIN WATER SYSTEM CONTACT PERSON INFORMATION (To be completed only if it's different from B.above) <br /> Name: Yasir (Steve) Khanshali Title: Owner <br /> Phone Number: 209-605-2370 Email Address: ooasis3@gmail.com <br /> Water System Mailing Address: 10,000 Crows Landing Road <br /> City: Crow Landing CA. 95313 <br /> Rev 11/2014 <br />