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COMPLIANCE INFO_2010 - 2015
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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88 (STATE ROUTE 88)
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2300 - Underground Storage Tank Program
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PR0505356
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COMPLIANCE INFO_2010 - 2015
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Last modified
11/20/2024 9:21:32 AM
Creation date
11/4/2018 5:30:25 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2010 - 2015
RECORD_ID
PR0505356
PE
2361
FACILITY_ID
FA0006733
FACILITY_NAME
GEORGES BP MINI MART
STREET_NUMBER
18662
Direction
N
STREET_NAME
STATE ROUTE 88
City
LOCKEFORD
Zip
95237
CURRENT_STATUS
01
SITE_LOCATION
18662 N HWY 88
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\E\HWY 88\18662\PR0505356\COMPLIANCE INFO 2010 - 2015.PDF
QuestysFileName
COMPLIANCE INFO 2010 - 2015
QuestysRecordDate
2/1/2018 7:40:19 PM
QuestysRecordID
3779163
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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• RECEIVED <br /> DEC 16 2015 <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> SERVICE REQUEST ENVIRONMENTAL <br /> Type of Business or Property NT <br /> FACILITY ID# SERVICE REQUEST# <br /> Gas Station Min Mart V <br /> OWNER/OPERATOR <br /> Rupi and Bill CHECK N BILLING ADDRESS <br /> FAciuw NAME <br /> Georges Mini Mart <br /> SHE ADDRESSt 6662 Highway 88 Lockford 95240 <br /> SIM M1 Na— CH <br /> HOME or MAILING ADDRESS (If Different from Site Address) <br /> Sheet NumberStre,t NMO <br /> CITY STATE ZIP <br /> PHONE#1 Err' APN# LAND USE APPLICATION# <br /> (209 ) 334-3233 <br /> PHONE 92 En- BOS DISTRICT LOCATION CODE <br /> ( 1 <br /> CONTRACTOR/ SERVICE REQUESTOR <br /> REDUESTOR Carrie Miller CHECK If BILLING ADDRESS® <br /> BUSINESS NAME PHONE# Err. <br /> Elite IV Contractors I 209l 461-6337 <br /> HOME or MAILING ADDRESS 2535 Wigwam Dr. FAX# <br /> (209 ) 461.6342 <br /> CITY Stockton STATE LP <br /> BILLING ACKNOWLEDGEMENT: 1, the undersigned property or business owner, operator or authorized agent of same, <br /> acknowledge that all site and/or project specific ENVIRONMEN'I'AL HF,ALTIi DEPARTMENT hourly charges associated with this project <br /> or activity will be billed to me or my business as identified on this form. <br /> I also certify that I have prepared this application and that the work to be performed will be done in accordance with all SAN JOAQ11IN <br /> COUN'T'Y Ordinance Codes,Standards re:and FEDERAL laws. <br /> APPLICANT'S SIGNATURE: _4y�Lg RA DATE: 12/16/15 <br /> PROPE.R7V/BUSINESS Ow:NERD OPERA'T'OR/MANAGER ❑ OTHER AUTHORIZED AGENT IR Office Manager <br /> If APPLICANT is not the BILLING PAR rr proof of authorization to.sign is required rule <br /> AUTHORIZATION TO RELEASE INFORMATION: When applicable, 1, the owner or operator of the property located at the <br /> above site address, hereby authorize the release of any and all results. geotechnical data and/or environmental/site assessment <br /> information to the SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT as soon as it Is available and at te time It is <br /> provided to me or my representative. ry� <br /> TYPE OF SERVICE REQUESTED: Replaced 67 LD Limit �� <br /> COMMENTS: '10 ,1 <br /> IkAtr4o0�/cT U/ti <br /> 4,9 <br /> rk <br /> T�FNT <br /> ACCEPTED BY: EMPLOYEE#: DATE: 14 1S <br /> ASSIGNEDTO: S N�G EMPLOYEES: DATE: 12 11 15 <br /> Date Service Completed (If already completed): 12/15/15 SERVICE CODE: SC/Iq e" I P"; <br /> E: <br /> Fee Amount: Q-VU Amount Pa 390. Payment Date l7 fS <br /> Payment Type / Invoice# Ck# 5��3 Received By: <br /> EHD 43-02-025 SR FORM(Golden Rod) <br /> REVISED 11/17/2003 <br />
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