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Service Request Information _ <br /> Facility ID: Related ID: Billing Account ID: Record ID: SR0080029 <br /> E]Update address Facility Name: Number: Direction: S-S Street name: CARROLTON <br /> - <br /> treet type: AVE-AVE Unit type: Unit: ity: RIPON ZIP Code: 95366 Site address: S CARROLTON AVE <br /> j GIS Latitude: Longitude: Place This Address on <br /> Add a Service Request Co Additional location information: APN: 124507089 Parcel size(acres): <br /> Entered date: 12/28/2018 Copy Address With: Location: 99-UNINCORPORATED AREA District code: 004-WINN,CHARLES <br /> Entered by: LSAUERS Update date: 3/12/2019 Update by: LTURKATTE2 <br /> j Property Owner Information <br /> Requestor Information <br /> Nature of Service <br /> Nature of service: NITRATE LOADING STUDY P/E Code: !2601 P/E Description: 2601-SOIL SUITABILITY OR NITRATE LOADING STUDY Special Permit <br /> Additional Information <br /> UST Retrofit <br /> ■ Leak Detector OSensor [,Spill Bucket Drop Tube <br /> ■ Cold Start <br /> ❑Secondary Containment Other: <br /> Well Replacement <br /> Replaced well is Viable Replaced well is Non Viable <br /> All Well and Septic <br /> F--lCosumnes Subbasin(5-22.16) ❑Q Eastern San Joaquin Subbasin(5-22.01) Tracy Subbasin (5-22.15) <br /> Water Sampling. <br /> OColiform and Gen Min(4391) F-1DBCP(4392) Arsenic(4393) <br /> Onsite Wastewater Treatment System <br /> epair Cause: Mier: <br /> Service memo: Received by: STEVEN SHIH Date: 1 12/28/2018igned to: NASEEM AHMED <br /> Date: 12/28/2018 Plan type: (none) Amount paid: $304.00 heck number: rchived: (none) <br /> Due date: ❑Requires further action <br /> ----- ....__. ..... <br /> Service Request Approval Dates <br /> Date request approved: Plan status: (none) Date revision requested: Last activity date: 1/9/2019 <br /> Date revision submitted: Final inspection: <br /> Add an Event Add a Certified Profe <br /> r,A <br />