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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT fteejuk.,_ <br />'C SITE MITIGATION MASTER FILE RECORD INFORMATION FO U <br />"MFR"- GREEN FORM JUL <br />DATE 6/15/18 <br />, <br />'vitt° ' cull ARE FOR EHD USE <br />PAIA,Tap. tAt <br />OWNER FILE: COMPLETE PROPERTY OWNER/ RESPONSIBLE PARTY INFORMATION: CHECK IF OWNER IS CURRENTL.WAFILE WIIAHD <br />PROPERTY <br />OWNER NAME <br />Heather Grove PHONE 209-239-8433 <br />FIRST MI LAST <br />BUSINESS NAME City of Manteca E-MAIL ADDRESS hgrove@ci.manteca.ca.us <br />OWNER HOME ADDRESS ATTENTION: ORCARE OF (ornonou.) <br />Crry STATE ZIP <br />OWNER MAILING ADDRESS 2450 W. Yosemite Ave <br />MAIUNG ADDRESS CITY Manteca STATE CA zip 95337 <br />1=1 CORPORATION <br />0 INDIVIDUAL <br /> 0 PARTNERSHIP /GOVERNMENT AGENCY 0 RESPONSIBLE PARTY <br /> 0 OTHER <br />/ ENVIRONMENTAL <br />ASSESSMENT <br />2950 <br />• EHD LOCAL VOLUNTARY <br />CLEANUP <br />2953 <br />RWQCB LEAD — RWQCB LEAD — DTSC LEAD <br />2959 <br />FED EPA LEAD <br />2954 CORRECTIVE ACTION <br />2960/3526/3527 <br />WATER QUALITY (WDR) <br />2965 <br />M • <br />FACILITY FILE: COMPLETE BUSINESS! SITE/ PROJECT INFORMATION: <br />IS THIS A NEW PROJECT LOCATION NOT PREVIOUSLY REGULATED BY THE ENVIRONMENTAL HEALTH DEPARTMENT? YES / NO 0 <br />IS THIS AN EXISTING PROJECT LOCATION, BUT A NEW SCOPE OF WORK? YES 0 No / <br />BUSINESS/FACILITY/SITE/PROJECT NAME Great Wolf Lodge APN <br />SITE ADDRESS / PROJECT LOCATION 2600 W Yosemite Ave BUSINESS PHONE 209-456-8000 <br />cny Manteca STATE cAzip 95337 <br />BOARD OF SUPERVISOR DISTRICT LOCATION CODE KENN KEY2 <br />MAILING ADDRESS, IF DIFFERENT FROM FACILITY ADDRESS 1 01 W Center St <br />MAIUNG ADDRESS CITY Manteca STATE CAzip 93557 <br />SIC CODE COMMENT: <br />REQUESTOR'S INFORMATION: <br /> <br />BUSINESS NAME Kleinfelder <br /> <br />ATTENTION Megan Murphy <br /> <br />MAIUNG ADDRESS 2001 Arch Airport Rd, Suite 100 <br /> <br />PHONE 209-948-1345 <br /> <br />cm' Stockton STATE CA ZIP 95206 EMAIL mkmurphy@kleinfelder.co <br /> <br />ACCOUNT ADDRESS To SEND FEES AND CHARGES: <br /> <br />OWNERD <br /> <br />FACILITY/BUSINESS/ <br /> <br />REQUESTORD <br /> <br />BILLING AND COMPLIANCE ACKNOWLEDGMENT: I, 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 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 SxN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT as soon as it is available and at the same time it is provided to me or my representative. <br />APPLICANT NAME (PLEASE PRINT) Megan Murphy <br /> <br />SIGNATURE - 47, • / c <br /> <br />Trn-E Staff Geologist <br /> <br />TAX ID* <br /> <br />FA #: ri i , no 7....Lf72....9 OWNER ID #: ta,0001333 .0. ACCOUNT #: A /44)017/2:7 / ASSIGNED TO: <br />PR #: 13o -q 51H ACCOUNTING COMPLETED BY: <br />/9 <br />DATE: 7/(ii 23- <br />SR TYPE PE SC FEE INFO AMT REMITTED CHECK# REM) BY DATE SERVICE REQUES INVOICE# <br />Work Plan 2903 <br />2904 <br />523 <br />523 <br />$456.00 <br />$760.00 $-(45A, 117S—filli. L----x hz i • Cv--co-ri.i 0 <br />Site Mitigation MFR 2-26-2018