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COMPLIANCE INFO_PRE 2019
Environmental Health - Public
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EHD Program Facility Records by Street Name
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F
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FREMONT
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1950
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2231-2238 – Tiered Permitting Program
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PR0507130
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COMPLIANCE INFO_PRE 2019
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Entry Properties
Last modified
8/24/2020 4:05:06 PM
Creation date
8/19/2020 1:57:36 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2231-2238 – Tiered Permitting Program
File Section
COMPLIANCE INFO
FileName_PostFix
PRE 2019
RECORD_ID
PR0507130
PE
2231
FACILITY_ID
FA0007428
FACILITY_NAME
TYCO/MAIN SITE
STREET_NUMBER
1950
Direction
W
STREET_NAME
FREMONT
STREET_TYPE
ST
City
STOCKTON
Zip
95203
APN
13336040
CURRENT_STATUS
02
SITE_LOCATION
1950 W FREMONT ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\gmartinez
Supplemental fields
FilePath
\MIGRATIONS\Tiered Permitting\F\FREMONT\1950\PR0507130\CONFIDENTIAL.PDF
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EHD - Public
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FACILITY/PI'U NAME S C (^I t- L.i fZ Q L I S ;L/V C , EPP IDNUMBER (-AP 1 O°( Z Z7 5`9,(; <br /> M. FINANCIAL ASSURANCE SELF CERTIFICATION OR EXEMPTION: <br /> This section is for an owner or operator of TTU, owner or operator of FTU, or a generator operating pursuant to a grant of <br /> Conditional Authorization who is cligible or ineligible for an exemption from financial assurance requirements pursuant to <br /> Title 22, CCR section 67450.13(e). If you are not certain as to whether you qualify for an exemption from financial <br /> assurance, please see instruction for this section. <br /> Please check the appropriate bax.- <br /> ❑ 1. As a TTU owner or operator or FTU owner or operator, I have not operated more than thirty days in a <br /> calendar year. <br /> Note: If box (1) is marked, your treatment unit(s) must be operating under PBR to be eligible for the 30 day <br /> exemption. Generators operating under Conditional Authorization are not eligible for this exemption. <br /> Be sure to sign the owner or operator certification below. <br /> ❑ 2. I am required to provide a mechanism and it is attached to this form. <br /> Note: If box (2) is marked, you must complete all sections of this form (DTSC 1232 (8/96)). Be sure to sign <br /> the owner or operator certification below. <br /> 3. I am not required to provide a mechanism. Specify why: C ST/M tT PC— IS L 0 SS Tftf <br /> IV. OWNER OR OPERATOR CERTIFICATION: <br /> 'I certify under penalty of law that this document and all ate:.:-Tents were prepared under my direction or supervision <br /> in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information <br /> submitted. Based on my inquiry of the person or persons who manage the system, or those directly responsible for <br /> gathering the information, the information is, to the best of my knowledge and belief, true, accurate and complete. I <br /> am aware that there are significant penalties for submitting false information, including the possibility of fines and <br /> imprisonment for knowing violations.' <br /> JFK TOHWSON G6NFe6L VA-fVR- G0,',) <br /> NAME (PRINT OR TYPE) TITLE <br /> )6k � <br /> SIG AT DATE SIGNED <br /> I ) ; j <br /> DTSC 1232 (8/96)Formerly 8113(1/96) PAGE 3 OF 3 <br />
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