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ATTACHMENT A <br /> CALIFORNIA REGIONALALITY CONTROL BOARD <br /> CENTRAL VALLEY <br /> NOTICE OF INTENT <br /> TO COMPLY WITH THE TERMS OF <br /> GENERAL WASTE DISCHARGE REQUIREMENTS ORDER NO,R5-2005-0149 <br /> IN-SITU GROUNDWATER REMEDIATION AT SITES WITH VOLATILE ORGANIC <br /> COMPOUNDS,NITROGEN COMPOUNDS,PERCHLORATE,PESTICIDES, <br /> SEMI-VOLATILE COMPOUNDS AND/OR PETROLEUM HYDROCARBONS <br /> 1. RESPONSIBLE PARTY INFORMATION <br /> Owner Name: <br /> Roger Huckins Jr. <br /> Mailing Address: <br /> 3436 Admiral Drive <br /> County: State: Zip: Telephone Number: <br /> Stockt oale:on San Joaquin CA 95209 209 957-4494 <br /> Stockt <br /> Operator Name(if different than above): <br /> Fernando Hatcher State: Zip: Telephone Number <br /> Mailing Address: County: CA 95206 209-915-9638 <br /> 1201 S Center St San Joaquin Title: Telephone Number. <br /> Contact Person: Same as above <br /> Fernando Hatcher <br /> Owner Type: <br /> (check one) Individual® Corporation❑ Parinershi ❑ Other: Trust <br /> 2LFemand'o's <br /> TREATMENT SITE INFORMATION <br /> e: <br /> Place <br /> Address:th Center Street ber.le: CouniySlate: Zip:San Joaquin CA 95206 209 915-9638 <br /> 3. LOCATION OF FACILITY Closest Surface Waler.(e.g.Sacramento River) <br /> Assessor's Parcel#: Mormon Slough—1.25 miles northwest <br /> 147-160-03 <br /> Township/Range/Section: <br /> T 01 N_R_06E_S9_Mt Diablo B&M <br /> F <br /> FOR FILING Changes in Ownership/Operator <br /> ot Study <br /> ll-Scale Treatment ❑Other <br /> Plot Study <br /> Full-Scale Treatment <br /> 9E9=999= <br /> MITSy issued permits or other entitlements(e.g.,conditional use permit,building permit,hazar ousge permd,air permit,well permit)for the site?®Yes❑Noit or entitlement,list the type,issuing agency,and date of issuance:odn ermits issued b the SJCEHD for environmental investi alions from 1998-2010. <br />