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SITE INFORMATION AND CORRESPONDENCE
Environmental Health - Public
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EHD Program Facility Records by Street Name
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BENJAMIN HOLT
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3011
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2900 - Site Mitigation Program
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PR0530063
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
2/6/2019 3:55:34 PM
Creation date
2/6/2019 3:42:59 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0530063
PE
2957
FACILITY_ID
FA0019769
FACILITY_NAME
FORMER SHELL GAS STATION
STREET_NUMBER
3011
Direction
W
STREET_NAME
BENJAMIN HOLT
STREET_TYPE
DR
City
STOCKTON
Zip
95219
APN
10018010
CURRENT_STATUS
01
SITE_LOCATION
3011 W BENJAMIN HOLT DR
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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TEL N0:4'1SS894809 <br /> TahJ—Gt3—'90 1 c ID:SHELL OIL <br /> CO <br /> NCORD u r p <br /> ^�'. ' Y SAN JOAOUIN LOCAL HEALT&ISTRICT Saav <br /> Jams CulbNuon,pea. CRY of <br /> Mety Ann,t aw,WW hM, 101 Earl Hazelton Avenue, P.O. 86K 2003 8•n JwaWn Co <br /> PoldwoILYfnavocl, `"'y, Uri JoKvinCol <br /> Tanury Joyce Stockton, California 08201 duty N aw <br /> too IkWitl Chy gf Mani <br /> WgMisa M.e,wn (203) 466.8781 Ohl of at. <br /> DeoW L Mw" city yf Steel, <br /> Jahn 0,Mail,M.D. Jogf Khu„u,14.0„M.RH„OHMot Haim wk" K, Chy of Tf <br /> ani,S.KNham Sl,n Ja,pvfn 1iw <br /> AUTHORIZATION TO RELVASt ANALYTICAL RESULTS, GROTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION <br /> If the undersigned owner and/or operator of the property and/or facility <br /> located at per/ /fir 'hs.;n. /OW ,, /V1 If <br /> hereby authorize .Q�ki.� _ .vs�+r �r✓,�.v �,.,�„l <br /> to release any and all analytical results, geotechnical data and Site <br /> assessment information to the San Joaquin Local Health District de goon <br /> as it is availapla and at- the Same time it is provided to me or my <br /> representative. <br /> 5lz 1a1��T <br /> f Owner/operator: om' Title; / <br /> Address Z p h o - " <br /> Darool 5 %O <br /> EH 23 041 3/86 <br /> Ell r/ <br />
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