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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> SITE REMEDIATION INFORMATION <br /> Site ID: SD 000 200( Case ID: RO 000201,4Existing FA <br /> Facility ID: <br /> SITE INFORMATION <br /> Business Name: -FEN /3 Phone: <br /> Street 4: I/00 Dir: Street Name: ! (C-K A1tV T-0 Type: <br /> City: .0 t State: ,A Zip: <br /> County: 39—San Joaquin County APN: <br /> CASE INFORMATION <br /> Program Element: 01-'7J D Assigned Name: MAAI�d t`l"L <br /> Regulatory Oversight Program: FSA <br /> A <br /> Funding for Regulatory Oversight: , <br /> Funding for Cleanup: <br /> File Location: L—Local Agency <br /> RISK MANAGEMENT <br /> ❑A-Drinking Water Supply Aquifer Affected ❑ F-Surface Water ❑ S-Soil Only <br /> Case Type: <br /> ❑ W-Drinking Water Well Affected U-Undetermined Affected <br /> Beneficial Use: MUN—Municipal and Domestic Supply <br /> Vulnerability Basis: <br /> MTBE Threat Classification: MTBE Cleanup Classification: I NA <br /> Number of Impacted Wells: 1 0 Well Impact Description: None <br /> CASE MANAGEMENT <br /> Brownfield: I ®N—Site is not part of Brownfield Site Management Requirements: NA—No Action <br /> Current Land Use: ❑ Agricultural V Commercial ❑ Industrial ❑Public Use ❑Residential <br /> ❑ Exclude from Export **Leave blank unless PE code is any 2900 sites.** <br /> Completed By: Date: <br /> Entered By: Date: <br /> EH-29- <br /> 09/18/2007 <br />