My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
COMPLIANCE INFO
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
M
>
MARCH
>
2701
>
2300 - Underground Storage Tank Program
>
PR0231176
>
COMPLIANCE INFO
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
3/22/2019 9:43:05 AM
Creation date
3/22/2019 9:37:26 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0231176
PE
2361
FACILITY_ID
FA0003798
FACILITY_NAME
MARCH LANE 76*
STREET_NUMBER
2701
Direction
W
STREET_NAME
MARCH
STREET_TYPE
LN
City
STOCKTON
Zip
95219
APN
11619007
CURRENT_STATUS
01
SITE_LOCATION
2701 W MARCH LN
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
Scanner
KBlackwell
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
46
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> SERVICE REQUEST <br /> Type of Business or Property FACILITY ID # SERVICE REQU ST # <br /> gas station �A QL2--. � <br /> OWNER / OPERATOR <br /> Darren Eppler CHECKIfBILL1NGADDRESS ❑ <br /> FACILITY NAME Unocal 76 (#255886 ) <br /> SITE ADDRESS 2701 W March ane , Stoc ton CA 95219 <br /> Street Number Direction streetName cityC <br /> HOME or MAILING ADDRESS (If Different from Site Address) <br /> Street Number StreetName <br /> CITY STATE zip <br /> PHONE #1 EXT• APN # LAND USE APPLICATION # <br /> PHONE #2 Exr. BOS DISTRICT LOCATION CODE <br /> CONTRACTOR / SERVICE REQUESTOR <br /> REQUESTOR Marty Weithman CHECK If BILLING ADDRESS <br /> BUSINESS NAME Service Station Systems , Inc. PHONE # EXT* <br /> 408 213-6038 <br /> HOME or MAILING ADDRESS 680 Quinn Ave FAX # <br /> (408 ) 213-6026 <br /> CITY San Jose STATE CA ZIP 95112 <br /> BILLING ACKNOWLEDGEMENT: I , the undersigned property or business owner, operator or authorized agent of same, <br /> acknowledge that all site and/or project specific ENVIRONMENTAL HEALTH 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 1 have prepared this application and that the work to be performed will be done in accordance with all SAN JOAQUIN <br /> COUNTY Ordinance Codes, Standards, STATE and FEDERAL laws . <br /> APPLICANT'S SIGNATURE ; cyDATE: 12/28/18 <br /> PROPERTY IBUSINESS OWNERO OPERATOR / MANAGER ❑ OTHERAUTHOR1zEDAGENT ✓Q Compliance Officer <br /> If APPLICANT is not the BILLING PARTY, proof of authorization to sign is required Title <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 the same time it <br /> provided to me or my representative , <br /> TYPE OF SERVICE REQUESTED : UST inspection r rarq <br /> COMMENTS: IVP <br /> ED <br /> JAN o 4 2019 <br /> SAN JOAQUIN COUNTY <br /> HEAL VIRONMENTAL <br /> ACCEPTED BY: � EMPLOYEE M (via DATE; At <br /> ASSIGNED TO . a� EMPLOYEEMelDATE: I C <br /> Date Service Completed (if already completed ) : SERVICE CODE: p 8 PIE ; <br /> Fee Amount: D U Amount Paid a (7p r Payment bate / 4 l <br /> Payment Type Invoice # Check # (4� Received By : 61 <br /> EHD 48-02-025 SR FORM (Golden Rod) <br /> REVISED 11 /17/2003 <br />
The URL can be used to link to this page
Your browser does not support the video tag.