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SU0007489 SSCRPT
Environmental Health - Public
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SU0007489 SSCRPT
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Last modified
5/7/2020 11:33:05 AM
Creation date
9/6/2019 10:02:39 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
FileName_PostFix
SSCRPT
RECORD_ID
SU0007489
PE
2622
FACILITY_NAME
PA-0800348
STREET_NUMBER
21301
Direction
N
STREET_NAME
MANN
STREET_TYPE
RD
City
ACAMPO
Zip
95220
APN
01728010
ENTERED_DATE
11/25/2008 12:00:00 AM
SITE_LOCATION
21301 N MANN RD
RECEIVED_DATE
11/24/2008 12:00:00 AM
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\M\MANN\21301\PA-0800348\SU0007489\SSC RPT.PDF
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EHD - Public
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� 10 <br /> c.1 I <br /> Surface/Subsurface Contamination Report Questionnaire <br /> IR Squared Project Number -- 2(108015 <br /> Property Location — 21301 N.Mann Road,Acampo,CA <br /> E N DORSEME NTS <br /> Part Two <br /> As the present owner of the property or as a repre.wntative of the present owner of the property, I am <br /> familiar with all of the operations prusentiy ccrrxlucted on the property,and hereb- certit} that to the hest of <br /> my knowledge,information,and belief the information disclosed aba)ve is true and correct <br /> I grant JR Squared Consulting Inc,permission to enter the subject property, including all structures <br /> on the property,as necessary to complete the Surface/Subsurface Contamination Report <br /> l understand that I will he given appropriate notice before the date of the site inspection at the phone <br /> nuum'beTj�VOW below. <br /> 7 <br /> Owner or Key Site Manager's Signature <br /> 070r)P-� Sia r r <br /> O%k.Teror Keti Site Manager's Name(please print) <br /> Title,Company <br /> 3,P Ql - 7 7-y / <br /> Contact Phone <br /> IR SQUARED CONSULTING.INC. ENVIRONMENTAL•ENGINEERING.GEOLOGY <br /> 6532 MCNE11.COURT,VALLEY SPRINGS,CA,95252 PHONE 1209)772 3841 PAX 12091740 4303 <br />
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