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UAR/PROP 65_PRE 2019
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2300 - Underground Storage Tank Program
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PR0231341
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UAR/PROP 65_PRE 2019
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Entry Properties
Last modified
9/15/2021 1:23:23 PM
Creation date
11/5/2018 3:48:10 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
UAR/PROP 65
FileName_PostFix
PRE 2019
RECORD_ID
PR0231341
PE
2361
FACILITY_ID
FA0003629
FACILITY_NAME
ARCO STATION #434*
STREET_NUMBER
501
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
03119028
CURRENT_STATUS
02
SITE_LOCATION
501 W KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\K\KETTLEMAN\501\PR0231341\UAR_PROP 65.PDF
Tags
EHD - Public
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v SAN JOAQUIN COUNTY .� COPYNOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEL: IDI III PHS-EH LOG # q,11-0—O 3-5 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION Phone: aro x/07- 49b`) <br /> Name: --1,— �on�1 <br /> Company: �a eo ova rS Go . <br /> Address: P o E3o2L to Jam+-�s�'¢ 9o7oZ - 6D 38" <br /> Designated Employee Name: Phone. L� <br /> Reporting AgencyName: <br /> Address: Sor94�� s r s �c fro 4�Zo( <br /> C. LOCATION AND DATE OF DISC GE <br /> Location: So 1 i <br /> (Best Physical Descriptio ) r County) Circle One <br /> Date of Discharge: <br /> Date Notified: 2 28 9 Time: 3 <br /> D. RESPONSIBLE PERSON/BUSINESS <br /> Name of Business: 04 ��S GD ' <br /> Contact Person: Telephone: yo <br /> aro <br /> Physical Address: o7oZ- 60 3� <br /> r4,4Mailing Address: y �3oX 6a 3� <br /> E. DESCRIPTION ,26ae4Sr� <br /> Type of Discharge: <br /> Volume: / C 1.1/' <br /> Chemicals oeE 04- <br /> Circumstances: 1Q0eo ���✓4s co s a3k rTE AnJ A �' row <br /> F. ACTION TAKEN_ 950 '6 <br /> �.eOAJLT G-r�C AS SOU Cy T/ /'�y�'" s91 D w <br /> EH 22 013 (Rev.4/91) <br />
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