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SAN JOAr'"N COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />SITE MITIG/.._.JN MASTER FILE RECORD INFORl 'ION FORM <br />"MFR"- GREEN FORM <br />DATE MARCH 20, 2019 SHADED AREAS FOR EHD USE <br />OWNER FILE: COMPLETE PROPERTY OWNER/ RESPONSIBLE PARTY INFORMATION: CHECK IF OWNER IS CURRENTLY ON FILE WITH EHD <br />PROPERTY <br />OWNER NAME <br />PHONE BILL ABOUMRAD 510-744-3530 <br />YUCEL CELEBI 510-673-5932 FIRST MI LAST <br />BUSINESS NAME TRACY ALLIANCE GROUP LLC <br /> <br />-MAIL ADDRESS BABOUMRADE@LEGACYREA.COM E <br />YUCELCELEBI@GMAILCOM <br />OWNER HOME ADDRESS ATTENTION: ORCARE OF (OPTIONAL) BILL ABOUMRAD <br />OR YUCEL CELEBI <br />Crry STATE ZIP <br />OWNER MAILING ADDRESS 41111 MISSION BOULEVARD <br />MAILING ADDRESS CITY FREMONT, CA 94539 STATE ZIP <br />0 CORPORATION <br /> <br />El INDIVIDUAL <br /> 0 PARTNERSHIP <br /> 0 GOVERNMENT AGENCY l=1 RESPONSIBLE PARTY <br /> <br />ID OTHER <br />xf ENVIRONMENTAL <br />ASSESSMENT <br />2950 <br />.1 EHD LOCAL VOLUNTARY . RWQCB LEAD — M RWQCB LEAD — <br />CLEANUP <br />2953 <br />CORRECTIVE ACTION <br />2960/3526/3527 <br />WATER QUALITY (WDR) <br />2965 <br />. DTSC LEAD M FED EPA LEAD <br />2959 2954 <br />FACILITY FILE: COMPLETE BUSINESS! SITE/ PROJECT INFORMATION: <br />IS THIS A NEW PROJECT LOCATION NOT PREVIOUSLY REGULATED BY THE ENVIRONMENTAL HEALTH DEPARTMENT? YES El NOISr UNKNOWN <br />Is THIS AN EXISTING PROJECT LOCATION, BUT A NEW SCOPE OF WORK? YES ID No ig UNKNOWN <br />BUSINESS/FACILITY/SITE/PROJECT NAME TRACY RIDGE APN: 213-170-27 <br />SITE ADDRESS / PROJECT LOCATION 6599 AND 6735W. GRANT LINE ROAD BUSINESS PHONE <br />Crry TRACY, CA STATE ZIP <br />BOARD OF SUPERVISOR DISTRICT LOCATION CODE KEY1 KEy2 <br />MAILING ADDRESS , IF DIFFERENT FROM FACILITY ADDRESS <br />MAILING ADDRESS CITY STATE ZIP <br />SIC CODE CommENT: <br />THIRD PARTY BILLING INFO: COMPLETE IF BILLING PARTY IS DIFFERENT FROM PROPERTY OWNER OR RESPONSIBLE PARTY IDENTIFIED ABOVE. <br />BUSINESS NAME ATTENTION: oRCARE OF (OPTIONAL) TERRACON CONSULTANTS INC <br />MAILING ADDRESS 902 INDUSTRIAL WAY PHONE 209-367-3701 <br />CITY LODI CA 95240 STATE zle <br />ACCOUNT ADDRESS To SEND FEES AND CHARGES: <br />OWNERE <br /> <br />FACILITY/BUSINESS0 <br /> <br />THIRD PARTY BILLIN <br />BILLING AND COMPLIANCE ACKNOWLEDGMENT: I, the undersigned Applicant, certify that I am the Owner, Operator, Authorized Agent, <br />or Responsible Party and I acknowledge that all PERMIT FEES, PENALTIES, ENFORCEMENT CHARGES and/or HOURLY CHARGES associated <br />with this project will be billed to me at the address identified above as the ACCOUNT ADDRESS for this site. I also certify that all information <br />provided on this application is true and correct; and that all regulated activities will be performed in accordance with all applicable SAN <br />JOAQUIN COUNTY ORDINANCE CODES and/or STANDARDS and STATE and/or FEDERAL Laws and REGULATIONS. As the undersigned <br />Owner, Operator, Authorized Agent, or Responsible Party for the project located above under facility/site address, I hereby authorize the <br />release of any and all results, reports, and other environmental assessment information to SAN JOAQUIN COUNTY ENVIRONMENTAL <br />HEALTH DEPARTMENT as soon as it is available and at the same time it is provided to me or my representative. <br />APPLICANT NAME (PLEASE PRINT) TERRACON CONSULTANTS INC <br /> <br />SIGNATURE <br /> <br />i'll/t& <br />TITLE ENVIRONMENTAL CONSULTANT <br /> TAx ID # <br /> <br />FA #: OWNER ID #: ACCOUNT #: <br />... <br />ASSIGNED TO: <br />PR #: ACCOUNTING COMPLETED BY: DATE: <br />9-3-2015 <br />Site Mitigation MFR 29-