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- I <br /> San Joaquin County Environmental Health Department <br /> DATE aq/I� MASTER FILE RECORD INFORMATION"MFR" OaREENFORM <br /> # t SITE MITIGATION&LOP <br /> OwffaiID# T0607700064 OAee# 1669 '5jLoo .1{ UNIT IV <br /> i <br /> t <br /> OWNER FILE:COMPLErE7HEFottomNG PROPERTY OWNER/NFDRMArIom- CleEorrnP OWNER CvaapprErpwpAeawn END <br /> PROPERIYOWNFANAME <br /> (253)896-8801 <br /> J F#sf MI Loaf PHOHENUM " i <br /> i <br /> BUSINESSNAME EaWILADDREss <br /> Tesoro Refining and Marketing Company Anastasia.E.Duarte@TSOcorp.com <br /> I Owner Hama Addram, <br /> i I <br /> �. <br /> CRY <br /> S ATE ZIP <br /> Owner Mailing Address <br /> 3450 South 344th Way,Suite 201 <br /> state Z <br /> Maiprg Addroaa City <br /> Aubum WA 96001-5931 <br /> i <br /> CORPD 7 INO AKRIAL❑ PARTNERSHIP❑ fEDAaanovO DRrcn o <br /> SITLMIYIGAMON X ENwRONMENTALASSIES MCNT_VOLONTARY CLEANUP_WATCR®OALRtl_NWPIPGLJNe INVESNGAMON_LOP_ <br /> FACIUTYID# Ilxy# ACCOUNT ID PR#JROq Aa610NED EMPLOYEE LEI{DAOEHCC EHD_RWQCB_DTSCEPA_�. <br /> 3�a T; S/R <br /> FACILITY FILE COMPLETE 7HEFOLLOWAW BUSTNESS:I FACILITY/SITE INFORMATION.' <br /> iIS this a NEW Business LOCATION not Previously regulated by the ENVIRONMENTAL HEALTH DEPARTMENT? YES, ❑ No 0 <br /> iIs this an EXISTING Business LOCATION buts NEW TYPE Ofregulated Busneess? Yes I] No <br /> BUMNessfFAcitmlSRe NAME <br /> Sire ADDREas auITE# BuslNPss PHONE <br /> 2132 E.Mariposa Road <br /> Ciro <br /> SSTATE zip <br /> CA 95206 <br /> iBOArtDOr SUPERVIBOR.RIBIWCI' LOCAnox CODE KEYt K@� <br /> i <br /> 1. MDliing Address ifOJFfEREAJrJsom FacdAyAddress Attentim-orCara Of(opAsm6f <br /> ' Tesoro Refining and Marketing Company Anne E. Duarte-Wilkinson <br /> Mailing Address City STATE ZIP <br /> 3450 South 344th Way,Suite 201,Auburn WA 98001-5931 <br /> SIOCOOE <br /> 173-06-35 SE Corner Farmington Rd/E Mariposa Rd <br /> THIRD PARTY BILIL NO:INPo: Complete if Billing Party is different from Property Owner orFacifity Operator identifiedabove <br /> Busm"I'sb butane Afterstlon:orCare Of/opWnafp <br /> Environ Strategy Consultants, Inc. Chris Guesnon <br /> MaRng Addreas PHORE <br /> 1036 W Taft Avenue,Suite 200 (714)919-6526 <br /> iDire STATE ZIP <br /> Orange CA 92865 <br /> i <br /> rU THIRD PARTY BILLING <br /> �aaawTA_—lmBFsZ4 ferfees-Birt}charges OWNER FADiLITY/BUSINESS <br /> i <br /> RILUNG AND C 1,the undersi¢ned ApPHennq certiry Eha[I am the Orvn r,Operamr,or Audrodred Ageni oreFNBn$nes;andl ackvmvledga tbm as PEaarrr Pk6, <br /> PEA:¢Tvrs, Boum r6Msacra naaciated with this opera#on avill be billed In mer at the address identified above ss Ne Ar.YnfWApa je;g for this si e. I slso eertiry thm <br /> ' oil Inrormation povitled on chis app4caxon is mia antl mrreer,and mm all r¢gi:lnted oeriyi11e5 Wal hepnrformetl In v¢nNancc with LI npplicablpsAN JOAQUm caemrY Ordiname Cudes anNor ' <br /> Standards nod STATE and/or FEUERaLLaws and RnNadons As the undersigned mraer,operator,or ageet Order molten,locmeda theobove fm]sYsiteaddrs,,I herehy,au0wrae the,des,or <br /> any and all resales and a nxronmemni assomemot beroranalum to SAN JOAQUIN COUNTY RNVIRONMExTAL HFALTH DEPARTMENT as men as it avoibble and at the came time it is <br /> provided to me ar my representative- <br /> APPLICANT NAME IPIFASEPRwiJN.Y.�i ,o✓aci SsNATsRE <br /> TITLE '� TAX ID# <br /> 33 - 076566 <br /> A proved By Osis pccounana Oaice Pmn eeinaCompleted By "Wb <br /> SITEMMOATON Amanow PAID DATE OP PAYMENTP°YMEHT TYPE RECFPr# CHECK# R EIVEssa WORK PIJUNpE <br /> FEE <br />