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-------------------------------- - ----------------------------- -------------------------- ----------- - - -— <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> - <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: wvvNv.sjgov.org/ehd <br /> SITE REMEDIATION INFORMATION <br /> Facility [D: <br /> Site ID: SDOOC)?,O?S' Case ID: I RO DO O�00(,4 Existing FA_T1dbZlb Sed <br /> SITE INFORMATION <br /> Business Name: THIZ65(� �f6�1,4 Phone: <br /> Dir: <br /> Street 4: Street Name: <br /> F— r 1 4 pf k7W(41Z Type: DR(w <br /> :Z,2qcS- 6, <br /> City: State: zip: <br /> County: 39—San Joaquin County APN: 4e —/4/0 <br /> CASE INFORMATION <br /> Program Element: I I Assigned Name: MAlNS1TF-_/a.VKc,,, <br /> Regulatory Oversight Program: C, 7-1 1� <br /> Funding for Regulatory Oversight: <br /> Funding for Cleanup: R <br /> File Location: L—Local Agency <br /> RISK MANAGEMENT <br /> Case Type: El A-Drhiking Water Supply Aquifer Affected ❑ F-Surface Water ❑ S -Soil Only <br /> F-1 W- Drirtkiiig Water Well Affected U-Undetermined Affected <br /> Beneficial Use: N/W Municipal and Domestic Supply <br /> Vulnerability Basis: F( A�� <br /> MTBE Threat Classification: MTBE Cleanup Classification: NA <br /> Number of Impacted Wells: 1 0 Well Impact Description: I None 0R (4 v Kov ow IV <br /> CASE MANAGEMENT <br /> Brownfield: I M N—Site is not part of Brownfield I Site Management Requirements: Action <br /> Current Land Use: I E] Agricultural IX Commercial F-1 Industrial 0 Public Use F] Residential <br /> F] Exclude from Export '"Leave blank unless PE code is any 2900sites.** <br /> Completed By: Date: 3 <br /> Entered By. Date: <br /> 2--/3 W <br /> 09/1812007 <br />