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California Environmental Reporting System (CERS) UST-Certification of Instal lation/Modification <br /> Facility/Site <br /> City gas and liquor CERS ID <br /> 16470 Cambridge Dr 10779784 <br /> Lathrop,CA 95330 <br /> Submittal Status <br /> Submitted on 1/11/2019 by AMARIIT KHINDA of City gas and liquor(Lathrop,CA) <br /> Submittal was Accepted;Processed on 1/14/2019 by Elena Manzo for San Joaquin County Environmental Health <br /> omments by regulator:This UST submittal was accepted by Elena Manzo,REHS,ICC Certified UST Inspector,on 1-14-2019. This acceptance is subject to verification <br /> A the next scheduled field inspection. <br /> Installation/Modification Project Description <br /> Description of Work Being Certified Work Authorized Under Permit(Number or Date) <br /> Yes Tank Installation or Replacement sr0076483 <br /> Yes Piping Installation or Replacement Description of Work Being Certified <br /> Yes Sump Installation or Replacement New UST installation <br /> Yes Under Dispenser Containment Installation or Replacement <br /> es Project Type:Other <br /> Contractor Information <br /> ame of Contractor Who Performed Installation/Modification Contractor's License Number Contractor's ICC Certification Number <br /> Elite IV 1001331 15746 <br /> 'Applicant Certification <br /> Certifier's Name Certifier's Title Phone Date Certified Certifier's Relationship to Tank Owner <br /> Name of Certifier's Employer <br /> Printed on 1/14/2019 1:53 PM <br />