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INSTALL 1995
EnvironmentalHealth
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6421
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2300 - Underground Storage Tank Program
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PR0231706
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INSTALL 1995
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Entry Properties
Last modified
6/11/2019 3:37:18 PM
Creation date
4/10/2019 1:40:43 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
INSTALL
FileName_PostFix
1995
RECORD_ID
PR0231706
PE
2361
FACILITY_ID
FA0000485
FACILITY_NAME
FLAG CITY CHEVRON
STREET_NUMBER
6421
STREET_NAME
CAPITOL
STREET_TYPE
AVE
City
LODI
Zip
95242
APN
05532024
CURRENT_STATUS
01
SITE_LOCATION
6421 CAPITOL AVE
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
KBlackwell
Tags
EHD - Public
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SO# So Owl.-;: site* <br /> AR a �zb �S �( o3a2 <br /> MONITOR WELLS <br /> Well Number 1 2 3 4 5 6 7 6 9 10 11 12 <br /> Well Depth <br /> Depth to Water <br /> Product Detected <br /> AMOUNT in inches <br /> Standard Symbols for diagram below: OFill 0 Vapor Recovery <br /> /B V.R. w / Ball Float O Monitor Well O Observation Well <br /> (Outside Tank Bed Area) (Inside Tank Bed Area) <br /> © Ball Float O Tank Gauge O Vent <br /> 0 Manway El Iron Cross Ifl Turbine <br /> Location Diagram-Include the.Vapor Recovery System. <br /> f OY^ Y tJ N Q 2 O L4 <br /> I q.1 <br /> vYa uN ✓�.UALSfh t. <br /> vv�u vNt, VN.� . . <br /> lalCu/VL $76cr91 <br /> . . . . . . . . . . . . fANr#Z. r�AL•SPk_r �\ <br /> . . . . . . . . . . . . . . . a � . <br /> ±-1i a ro�Ncp aC& �� SRP ok o <br /> �,� N Ntp y. �jy <br /> l Uri L 1 � I F �4N U,�L V,C t !/ <br /> d <br /> �. . . L �A e �-o.,,-, . . . . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . I . <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> Vapor Recovery System & Vents were tested with which tank? # <br /> Parts and Labor used <br /> General Commentsi4��� P�or�,, C-f <br /> nl 'S —t— L '5 Q F7 f / , � t�f} M cJ G7 C ret w <br /> Re GP_o>',)cfi f SOC S Q Cc S F <br /> A� 50 / Qlvl ,,\/ C � � �✓� �. <br /> ti L c oa i-c o w iA C "o-jLoS <br /> When OWNER or local regulations require immediat reports of system failure-Complete the following: <br /> REPORTED NAME DATE TIME <br /> TO: <br /> Phone# OWNER or Regulatory Agency FILE NUMBER <br /> Print:Cent ed Testers Name Vacutectm Ce Dation Number <br /> f�U eN A�_J 1-,o S I b 6, <br /> Certified Testers Signature Date Testing Completed <br /> S-- <br /> Form-Tar"um*4W <br />
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