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COMPLIANCE INFO 2007 - 2009
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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PR0231035
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COMPLIANCE INFO 2007 - 2009
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Last modified
10/3/2022 4:54:02 PM
Creation date
3/27/2019 1:36:28 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2007 - 2009
RECORD_ID
PR0231035
PE
2361
FACILITY_ID
FA0006773
FACILITY_NAME
ARCO 02186
STREET_NUMBER
3212
Direction
N
STREET_NAME
CALIFORNIA
STREET_TYPE
ST
City
STOCKTON
Zip
95204
APN
12532001
CURRENT_STATUS
01
SITE_LOCATION
3212 N CALIFORNIA ST
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
Scanner
KBlackwell
Tags
EHD - Public
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Owner Statemet of Designated Underground Stc a Tank (UST) Operator <br /> and Understanding of and Compliance with UST Requirements <br /> Facility Name: BP 02186 Facility ID: 02186 <br /> Facility Address: 3212 N CALIFORNIA Reason for Submitting this Form (Check One) <br /> STOCKTON, CA 95204 ■ Change of Designated Operator <br /> Facility Phone#: 2099412694 ❑ Updated Certificate Expiration Date <br /> Designated UST Operator(s) for this Facility <br /> PRIMARY <br /> Designated Operator's Name: Jhustin Abeleda Relation to the UST Facility (Check One) <br /> Business Name(If different from above): Belshire Environmental Services, Inc. ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#: (949)460-5200 ❑ Service Technician ■ Third-Party <br /> International Code Council Certification#: 8036229-UC Expiration Date: 9/26/2011 <br /> ALTERNATE 1 <br /> Designated Operator's Name: refer to backup document Relation to the UST Facility (Check One) <br /> Business Name(If different from above): refer to backup document ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#: refer to backup document ❑ Service Technician ■ Third-Party <br /> International Code Council Certification* refer to backup document Expiration Date: refer to backup document <br /> ALTERNATE 2 <br /> Designated Operator's Name: refer to backup document Relation to the UST Facility(Check One) <br /> Business Name(If different from above): refer to backup document ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#: refer to backup document ❑ Service Technician ■ Third-Party <br /> International Code Council Certification#: refer to backup document Expiration Date: refer to backup document <br /> 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, regulations, <br /> and local ordinances) applicable to underground storage tanks. <br /> Name of Tank Owner (print): Stephen Comley <br /> Signature of Tank Owner: - t '-�' 1 <br /> Date: 11/23/2009 Owner's Phone #: (714) 228-6480 <br /> NOTE: 1)SUBMIT THIS COMPLETED FORM TO THE LOCAL AGENCY(NOT THE STATE WATER RESOURCES CONTROL BOARD)BY <br /> JANUARY 1, 2005.THE LOCAL AGENCY LIST IS AVAILABLE AT:www.waterboards.ca.gov/ust/contacts/cupa_agys.html. <br /> 2) NOTIFY THE LOCAL AGENCY OF ANY CHANGES TO THIS INFORMATION WITHIN 30 DAYS OF THE CHANGE. <br />
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