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SU0005992 SSCRPT
Environmental Health - Public
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SU0005992 SSCRPT
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Last modified
12/13/2019 11:08:27 AM
Creation date
9/6/2019 10:23:31 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
FileName_PostFix
SSCRPT
RECORD_ID
SU0005992
PE
2622
FACILITY_NAME
PA-0600182
STREET_NUMBER
14101
Direction
N
STREET_NAME
JACK TONE
STREET_TYPE
RD
City
LODI
Zip
95240
APN
06325027
ENTERED_DATE
4/12/2006 12:00:00 AM
SITE_LOCATION
14101 N JACK TONE RD
RECEIVED_DATE
4/11/2006 12:00:00 AM
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\sballwahn
Supplemental fields
FilePath
\MIGRATIONS\J\JACK TONE\14101\PA-0600182\SU0005992\SSC RPT.PDF
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EHD - Public
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Surface and Subsurface Contamination Report Questionnaire <br /> NOA Project Number: <br /> Property Location: 13737 N. Jack Tone Rd., Lodi, CA <br /> Page 5 <br /> NEIL O. ANDERSON Et ASSOCIATES, INC. <br /> ENVIROMENTAL QUESTIONNAIRE AND DISCLOSURE STATEMENT <br /> PART 2: OWNER INFORMATION <br /> (To be completed by Owner or Owner's representative) <br /> I. GENERAL INFORMATION <br /> 1. Current owner of property t 1 1 <br /> Name:Tokn 6r" M(tiri1a- 1 tOLOIP-5 <br /> Address: <br /> r Telephone: <br /> Year purchased: a0b�j <br /> 2. Previous owner(s) and contact information (if known): ��_(_tt <br /> Name: He.(S� I�YILtiY-'O1 &*Ad, (CKe Spe-eol �e- <br /> Address: J3-7b-7 N , �j G. Cf PGQ , <br /> Telephone: 333 — 2 91 <br /> Year purchased: <br /> r <br /> 3. Other person with historical knowledge of property: <br /> Name: <br /> Address: <br /> Telephone: <br /> Relationship to property: <br /> 4. Please describe current use(s) of property: Pq-s+t ,r—(�., ci—� ©ce+s) V Vl r- <br /> 4h2 I as+ 2-z y ear-5 <br /> 5. Please describe any other known past use(s) of property, and approximate dates of each use: <br /> V. /f you have any questions about this questionnaire,please contact Abby Rocco at(209)367-3701 ext. 238. <br />
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