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0 <br /> San Joaquin County Environmental Health Department <br /> DATE MASTER FILE RECORD INFORMATION "MFR" GREEN FORM <br /> SITE MITIGATION$LOP <br /> SHAIEpuIEAf SAEND ME ONLY DMR ID. GAVE UNIT IV <br /> OWNE_RFILE:COOPLE7EPROPERTYOWNEWRESPONSIBLE PARTY_/NFOte 4rioN. CwmwOWNER CVAIIENnYONFILEwn END <br /> PROPERTY TANNER NAPE Steward Subek _ - (41$) 617-5791 <br /> Finl 41d La SI pwoos NUMBER, <br /> BuswE"NAYE Stuart Limited Partnership E E.ADDRESS <br /> Owner Horne AWd <br /> City STATE 2a <br /> OINnw MoN ing Address P.O. Box 370055 <br /> MdungAade..ehy Las Vegas StOe NV <br /> 89137 <br /> ❑CDRPORATION 0 MGMDUAL F1 PAATNEASNIP ❑GoVERN WAGENCY D RESPoKau LE PARTY ❑OTHER <br /> SITE MITIGATION _ENVIRONMENTAL ASSESSMENT rL VOLUNTARY CLEANUP_WATER QUALITY_HW PIPELINE INVESTIGATION_LOP <br /> FACILITY IDB IRv/ AccouNT ID PRf/ROT AMOENPLOMM LUSSAIRMcY:EHO-11 <br /> 1s wfu <br /> FACILITY FILE: COMPLETE BUSINESS/SITE/PROJECT 1NFORMAr/ow <br /> IS this a NEW Project LOCATION not previal dy regulated by the ENWRONMENTAL HEALTH DEPARTMENT? YES El No ❑ <br /> IS this an EXISTING Project LOCATION but a NEW SCOPE OF WORX? YES ❑ No 91 <br /> sUII SIMACADYISr1EIPRORCTNME Quality Cleaners,Tracy Corners Shopping Center <br /> SITE ADDRESS I PROJECT LOCATION BURET BUSINESS PHONE <br /> 3081 North Tracy Boulevard <br /> Gm STATE ZAP <br /> Tracy G CA 95376, <br /> SOUND OF SYPERVIBOR DKTRN:T J LOCATMJM CODE NEYT NEY2 <br /> Moiling Address tfDIFFEREArrfro/n FaNNyAdDyss Attention:are"Or fapbwMq i <br /> Mailing Address City STATE LP <br /> SIC CODE AT COMMENT: <br /> DIY • V <br /> THIRD PARTY BILLING INFO: Complete if Billing Party is different from Property Owner or Rea nsible Party rty idenlfTied above. <br /> BUSINESS NAYS Partner Attention:orGare Of fop""wj�. <br /> I rtner Engineering and Science, Inc. rum Campbell <br /> Moiling Address 2154 Torrance Boulevard, Suite 200 PHONE 508-876-2660 <br /> CITY STATE 2M <br /> Torrance CA 90501 <br /> ACl;w rAaWZ for fees and Charges OWNER FACtuTylBUSINESS THIRD PARTY BILLING <br /> BILLIw.%Nn CDYPIIAxI At'A]UxIAIR:YFYI: 1,Or xnd,,H,m \pPlkaal•,ruff,Ihal Jam Me IA,.rrr.44r 'Ar..l mhndT.d A .W.n A"'r ihle•PPM'aM 1- -Wp dnl an PLA411 I'n,, <br /> PL'd1 HE%E%IORi F.NFII 014^0 a1M4fM Ifo/R/1 widr Min tnyjrrl-M Iw NNkIl In nx ar rlr aAdrea•ilrnliliM aMir—IIN dt 111,11 I/tlMF\\rw Ih64. 1.6."'flf,Ihal A[ <br /> infarnYlbn p.'n l I.Ak gA,lkuiu.S w—and'n , and ihn a1I r,NIA xrP,kws.ill le pe,KK-.M i-I Hith xll sPNidble S\1-0-%Q1 n(OL N11 011141-11,Enda arxVur <br /> Srnndards act Sbu E aalmr FI:nFxAt in,,,act NRA4Mxn AS IM nndfr•iLmd I Mme GtAranr.>...Mrwd \Eml.nr Neryxxnible Para Inr IND prnjrn IM'vlat untie uMrr fxiNM1:xitr nAArm>.1 <br /> hertb}awhurizr IIY rnkau nram act dt radb,rtror4 mnl rAMr m,irmmrewl uxi.nHnr inlunmrirm xr SAN Ar I\)I IN E(HN 1) LN IRONMYNT AI.I It\I I I I DFP%R 1\I IN I.1 rum na u <br /> ma,ailnbk mal ar rhr eanrr limrni\pn.idrd to n,r or rm nprrumari<e. <br /> APPLICANT NAME(PLEASEPRWT) Tum Campbell SIONATURE <br /> TITLE T. TAX IDs ,h-X2643?9 <br /> 1 IOII'il �'laneael <br /> I _ <br /> Approved BVOgle Ammml, D Off.RA.....CoinpWlPd BY DAL. <br /> SITE M'liLAiION AWUM PAID DATE OrPRYEm PIYYEMT TYPE RECEIPIa CHECK RECE vrD 0, 1 WORK PLAIN PE Y <br /> FEE.{ a 3Yo /'�tS QHetK o <br /> - -- - - _ _ _ -- � !s.O <br />