Laserfiche WebLink
1 <br /> ' 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. R5-2008-0149 <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: �1 <br /> CALIFOKIJIA , rE Gntirl2a� V �S DFrPeI ..c - 0t4C&_A1r-jGD RZO <br /> Mailing Address: .1'1l <br /> l0000 WH17EjRoLIL 'RoA7> Sul-TE I + I <br /> ity/Locale: C linty: State: Zip: elep one Number: <br /> ' v t�dfl Meri T a (0�2� 46 - 60 19 <br /> Aerato (ifI different than above): <br /> Lt <br /> r Name EPA2 CN aFIIt4ZAL <br /> Mailing Address: $,;ITCounty:W15 i State: Zip: Tele ne Number: <br /> o•} 3�Sr 3o MENT'D Lo Gla loo �1W 374-110 5-31L* <br /> 4pPntaict erson: tle: Telephone Number: <br /> MR. �D'I -FFAP, R0M3:-T" Ib 11?. G - Ck . <br /> Owner Type: � 1� <br /> ' (check one) Individual E] Corporation [I Partnership N Other: Y V (.. - 4c <br /> 2. TREATMENT SITE INFORMATION <br /> Site Name: i� <br /> ' <br /> FORMER V t P6jj <br /> Physical Address: G O 1 r—: I a�� A� E• <br /> C'y/Locale: County: . St te: Zip: Tele hone Number• <br /> S' S� U I n1 zoz 9 e SN z <br /> 3. LOCATION OF FACILITY <br /> Assessor's Parcel#: f '3R '3 1025 Closest Surface Water:(e.g.Sacramento River) <br /> ' <br /> Township/Range/Section- MLI-CoA I AKE- <br /> Tf t4 R 6 S_22q?�_BBM <br /> ' 4. REASON FOR FILING <br /> ❑ New Pilot Study ❑Changes in Ownership/Operator <br /> ' [TfJew Full-Scale Treatment <br /> El Other <br /> E] Update Plot Study <br /> ' ❑ Update Full-Scale Tretament <br /> 5. LOCAL PERMITS <br /> ' Has an agency issued permits or other entitlements is"" <br /> condit' al 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: <br /> ' ShN4 _2 co irlCojo:! / E 4 b k1 PC-isZMITT <br />