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BILLING 2013 - 2015
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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PR0231459
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BILLING 2013 - 2015
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Entry Properties
Last modified
10/10/2023 1:32:13 PM
Creation date
11/7/2018 12:27:33 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
BILLING
FileName_PostFix
2013 - 2015
RECORD_ID
PR0231459
PE
2361
FACILITY_ID
FA0003677
FACILITY_NAME
DIAMOND GAS AND FOOD MART
STREET_NUMBER
824
Direction
E
STREET_NAME
YOSEMITE
STREET_TYPE
AVE
City
MANTECA
Zip
95336
APN
22118003
CURRENT_STATUS
01
SITE_LOCATION
824 E YOSEMITE AVE
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\Y\YOSEMITE\824\PR0231459\BILLING 2013 - 2015.PDF
QuestysFileName
BILLING 2013 - 2015
QuestysRecordDate
7/12/2017 9:11:23 PM
QuestysRecordID
3341525
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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« RECEIVED <br /> Owner Statements of Designated Underground Storage Tank (UST) OperattjCR <br /> and Understanding of and Compliance with UST RequirNMENTAL <br /> Facility Name:Kwik Sery Facility ID#: FMI <br /> Facility Address:874 E Yosemite Ave Reason for Submitting this Form(Check One) <br /> Manteca,CA.95336 X Change of Designated Operator <br /> Facility Phone# Update Certificate Expiration Date <br /> Designated UST Operator(s) for this Facility <br /> PRIMARY <br /> Designated Operator's Name:Karen R ArnaiZ Relation to UST Facility(Check One) <br /> Business Name(If different from above): ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#:(209) 518-4836 ❑ Service Technician X Third-Party <br /> International Code Council Certification#:8032295-UC Expiration Date:05/31/2015 <br /> ALTERNATE 1(Optional) <br /> Designated Operator's Name: Relation to UST Facility(Check One) <br /> Business Name(If different from above): ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#: ❑ Service Technician ❑ Third-Party <br /> #International Code Council Certification#: Expiration Date: <br /> ALTERNATE 2 (Optional) <br /> Designated Operator's Name: Relation to UST Facility(Check One) <br /> Business Name(If different from above): ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#: ❑ Service Technician ❑ Third-Party <br /> International Code Council Certification#: Expiration Date: <br /> I certify that, for the facility indicated at the top of this page, the individual(s) listed above will <br /> serve as Designated UST Operator(s). The individual(s) will conduct and document monthly <br /> facility inspections and annual facility employee training, in accordance with California Code of <br /> Regulations, title 23, section 2715(c) - (f). <br /> Furthermore, I understand and am in compliance with the requirements (statutes, <br /> regulations, and local ordinances) applicable to underground storage tanks. <br /> NAME OF TANK OWNER(Please Print): VQ lip,r 1qnan rr L <br /> SIGNATURE OF TANK OWNER: �... . n <br /> DATE: 02/03/14 OWNER'S PHONE# IrA Q-2 —7 <br /> NOTE: 1)SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY(NOT THE STATE WATER <br /> RESOURCES CONTROL BOARD)BY JANUARY 1,2005.THE LOCAL AGENCY LIST IS AVAILABLE <br /> AT: www.waterboards.cd.gov/ust/contacts/cupa agys.html. <br /> 2)NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS <br /> OF THE CHANGE. <br /> November 2004 <br />
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