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COMPLIANCE INFO_PRE 2019
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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KETTLEMAN
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2300 - Underground Storage Tank Program
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PR0231345
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COMPLIANCE INFO_PRE 2019
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Entry Properties
Last modified
5/20/2019 1:40:56 PM
Creation date
10/11/2018 2:50:53 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
PRE 2019
RECORD_ID
PR0231345
PE
2381
FACILITY_ID
FA0003713
FACILITY_NAME
CHEVRON #95775 MCCOMBS* (INACT)
STREET_NUMBER
301
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
04514002
CURRENT_STATUS
02
SITE_LOCATION
301 W KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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KBlackwell
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EHD - Public
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SO# 072, 3q OwSite# <br />' flc-- vR�/ �n5 <br />77 <br />% ,,5 <br />O <br />Ul . . . . . . . . . . . . . . . . <br />. . . . . . . . . . . . . . . . <br />MONITOR WELLS <br />Well Plumber <br />1 <br />2 <br />3 <br />4 <br />5 8 7 <br />8 <br />9 1® <br />1 1 <br />12 <br />Well Depth <br />qz <br />Depth to Water <br />Product Detected <br />ASAOUNT in inches <br />Standard Symbols for diagram <br />below: F Fill V <br />Vapor Recovery <br />/B V.R. w / Ball Float <br />O Monitor Well <br />Observation Well <br />OB Ball Float <br />(Outside Tank Bed Area) <br />GO Tank Gauge O <br />(Inside Tank Bed Area) <br />Vent <br />® Manway <br />E1 Iron Cross 0 <br />Turbine <br />Location Diagram—Include <br />. . . . . . . . . <br />the Vapor Recovery System. <br />. . . . . . <br />. . . . . . <br />. <br />. . . . I <br />. <br />...... ..... <br />.... ....� <br />.... . . <br />. <br />. . . i . . . . ... <br />6 <br />i <br />ktC <br />.... <br />. <br />. <br />W <br />I <br />i <br />R- -r i 1,, <br />02. <br />rot t'1ty� Lril�� 8 <br />bO <br />O <br />Ul . . . . . . . . . . . . . . . . <br />. . . . . . . . . . . . . . . . <br />................ ......II <br />. . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />Vapor Recovery System & Vents were tested with which tank? <br />Parts and Labor used <br />General Comments <br />When OWNER or local regulations require immediate reports of system failure -Complete the following: <br />REPORTED NAME DATE TIME <br />TO: <br />Phone# OWNER or Regulatory Agency FILE NUMBER <br />Print Certified TestersName Vacutec" Certification Number <br />l/tJ�2� A Lac 22 <br />Certified Testers Si natum % Date Testing Completed <br />Form-TarkWLWaa-G/W <br />
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