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ATTACHMENT A <br /> CALIFORNIA REGIONAL WATER QUALITY CONTROL BOARD <br /> CENTRAL VALLEY REGION <br /> NOTICE OF INTENT <br /> TO COMPLY WITH THE TERMS OF <br /> GENERAL WASTE DISCHARGE REQUIREMENTS ORDER NO. R5-2068-0149 <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 /> John Parker <br /> Mailing Address: <br /> 414 Meadowlark Way <br /> City/Locale County State: Zip: Telephone Number: <br /> Lodi San Joa uin CA 95240 209-466-2715 <br /> Operator Name(if different than above): <br /> Same as above <br /> Mailing Address: County: State: Zip: Telephone Number <br /> Contact Person: Title: Telephone Number: <br /> Owner Type: <br /> (check one) Individual® Corporation❑ Partnership❑ Other. <br /> 2. TREATMENT SITE INFORMATION <br /> Site Name: <br /> Boulevard Automotive Service <br /> Physical Address: <br /> 2151 Country Club Boulevard <br /> City/Locale: County: State: Zip: Telephone Number: <br /> Stockton San Joa uin CA 95204 20&466-2715 <br /> 3. LOCATION OF FACILITY <br /> Assessor's Parcel#: Closest Surface Water:(e.g.Sacramento River) <br /> 123-080-30 -Smith canal(south) <br /> Township/Range/Section: <br /> T 2N R 6E S East of 6 Mt. Diablo B&M <br /> 4. REASON FOR FILING <br /> ® New Pilot Study ❑Changes in Ownership/Operator <br /> ❑New Full-Scale Treatment <br /> ❑Other <br /> ❑Update Plot Study <br /> ❑Update Full-Scale Treatment <br /> 5.LOCAL PERMITS <br /> Has an agency issued pemrits or other entitlements(e.g.,conditional use permit,building permit,hazardous <br /> materials storage permit,air permit,well permit)for the site?®Yes❑No <br /> For each permit or entitlement,list the type, issuing agency,and date of issuance: N/A <br />