Laserfiche WebLink
it <br /> __ __• San toaquin County Environmental Health <br /> BATE ) Z I Iy I ! O MASTER FILE RECORD INFORMATION I"MI: � ;I' 3REENFORM <br /> ` SITE M®®ITiGAnON & LOP <br /> SHADED MEAS FOR EHO USE ONLY OWNER ID# CARE# L/ N '� IV <br /> OWNER FILE .C0hftE7F TNEFOLLOWJNG PROPERTY OWNER /NFoRmAnome CNrcKip OWNER OVARENTLYONN/ W11N END <br /> PROPERIVOWNERNAME WILLIAM STOERMER 20$ 465-8200 <br /> Flrs( M7 Las! PHONE/NUMBER <br /> BUSINESS NAME FREMONT PLAZA IN_ VESTMENTS LP EMAILAODRES9 <br /> bstoermerNsanda:L oodme . com <br /> Owner Home Address 7015 MORTON COURT <br /> CRY STOCKTON STATE CA ZP 95205 <br /> Owner Naffing Address. 7015 MORTON COURT <br /> Mailing Address CRY STOCict'ON ray SMta CA ZIP 95205 <br /> CDppomTRM ❑ INDIVIDUAL❑ PARTNERSHIP LJ Fan AGENDY ❑ OTHER El <br /> SITE MITIGATION — ENVIRONMENTALAiNgEtWENT_ VOLUNTARY CLIMANUP —WATER QUALITY _ HW PIPELINE IMMSnGATION_LOP _ <br /> FAOILITYID# INv# ACCOUNT ID PRf#RO# AwIGNEo EMPLOYEE LEAOACENOY: EHD_RWQCB_DTSC _EPA <br /> _ �t0ll 5,105 1 o " b S l rx <br /> FACILITYFILE CDNPLE7E7HEFOLLOW/NOBUSINESS / FACILITY / SITE /NFORNAYWN.' <br /> Is this a New Business LOCATION not previously regulated by the ENWRONMEWAL HEALTH DEPARTMENT? YES ❑ No p� <br /> Is this an EXISTING Business LOCAaON beta NEW TYPE of regulated Buldness? YEe ❑ No L� <br /> - 1guwNEsWAcILRYISaENAME APACHE PLASTICS (former) <br /> SIIEAunREas 2050 EAST FREMONT STREET SurrE# BUSINESS PHONE <br /> 209-931- 7070 <br /> Cal' STOCKTON STATE CA ZIP 95209 <br /> BOARDOFSUPERVISOROIBTNCT LO MON CODE KEY1 KEY2 <br /> Mailing Address /fD1nWRENThnnf faalldyAdb Attention: arCare Of (op&wa/J <br /> Melling Addreaa City STATE ZIP <br /> SICCODE AEN# COMMENT: <br /> THIRD PARTY BILLING INFOI Complete if Billing Party is different from Property Owner orFaoility Operator idenfif/ed above. <br /> BUSINEa6NAME Attention: orCare Of (OpVonodl <br /> MallinGAddrass PHONE <br /> 0" STATE ZIP <br /> d©aQVArAf1bHEa4 feffees and Chargee OWNER FAciuTy/BUSINESS THIRDPARTY BILLING <br /> 1fILIJNG Atm COMPI:LiNCR ACKNOWLEDr.INRNT: l; Me aodemigned ApplicaU4 certify that I em the Owner, Operoter, or Am1w ked Agent of this Outlets% and I aclmowledge that all YeSAIIrpaEy, <br /> 1!u A tYP9,SNPI)RCfID Cj Gm maVor H0VAFCtt&V? s7mRceated wide ads operation will hebiNed tome at the address identified above as theAt;rovw'ADDRE45 for this aim Ialsocerliry Umt <br /> all information provided an this appdcafion is true aM correct; and that all regulated activifies will be performed in accordance with all applicable SAN JOAUmN CorR rY Ordinance Codes and/or <br /> Standards and STATE and/or FEDERN. I:aws and Rcguladons. M The underaigned owner, operator, or agent of the property located at thea one facility/site address, I hereby authorize the releme of <br /> any and all reaulh and . mental asseomeat Information to SAN JOACHIM COUNTY ENVULONMENTAL HEALTH DEPART as it " gable end at the same time it is <br /> provided to me or my representative. <br /> APPLICANT NAME.(PLEAsimPRIW) WILLIAM STOERMER. SIGMTURE <br /> TITLE PARTNER 'TAX Q 7/55-2988i836.Q TT <br /> Approved By Data Aucoyntlng OiRce Praceeeng completed BY Dale <br /> SITEMITIGATION AMOUNT PAID OATEOFPAYMENT PAYMENTTVPE RECEIPT# DHECK# RECEIVED BY WORKPt NPE <br /> FEE: III <br />� 3s2 � <br />