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COMPLIANCE INFO_PRE 2019
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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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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10 <br />INVENTORY RECONCILIATION <br />QUARTERLY SUMMARY REPORT FORM <br />racUity Nast _�od /�%��,bs <br />Tant <br />racUity /lddeea.t 3o e-�// <br />Telephone: '�?og) 3�d �6/� <br />Person Filing <br />Report 1lviliov, <br />tQPrlduct <br />1 hereby cectify,nader penalty of perjury that all inventory variations for <br />Cbe above reatioaed facility were within the allowable limits for this <br />1(.aetee. (IRO ilk Coluan 13 of the laventory Reconciliation Sheet) <br />taventocy vaciatioas exceeded the allowable limits for tbis quarter. I <br />Hereby certify radec penalty of perjury that the source for the variation <br />was not due Co as unauthorised (leak) cc Lease. (Yes in Column 13 of the <br />lnventocy Qeeoaciliation Sheet) <br />List date, tank 1, aad asount for all variations that euceeded the <br />allowable knits_ <br />Date Tank I Amount <br />rlddlCtoaal daces/amoun(A chall be conCtoucd on s scparace shcec of <br />Pahcr and aC(achcd. <br />lC <br />the source of (t,r varta(t')r, vl„ih c s <br />c.•cdf•d .fl l�wahlc ltmt(� vas due to <br />• leak (he tnctdcn( chill br i.l„rtrrl to <br />� ) 1 11 1) Env t roruncnr a l Ileal ( h <br />`ctChtn 24 houff and an un.,u(h„ ,:�.1 <br />f.-lf.7bmlC(Ct1. <br />Ilk Qua C aumttary rc"r( th.all Lr a•�bmlC(,d vl(h,n <br />day: of the end of etch <br />11,„r(rf <br />QtiarCCr I <br />Januarr <br />Q•aar(cr 2 <br />A(,r i l <br />Quarter ) - <br />July --> ir�(emh,•f <br />Qaar(Cr 4 - <br />October --) I1.•C,•mhCf <br />Send Co' SAN JOAQU IN 1.(1f:Al. HEALTH <br />1601 E. I!az(. I t fill • 1, .0 Itftx0 10/H6 <br />Stockton. CA 1/5101 466-6AI <br />
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