My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
COMPLIANCE INFO_1995-2004
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
C
>
COUNTRY CLUB
>
2575
>
2300 - Underground Storage Tank Program
>
PR0231070
>
COMPLIANCE INFO_1995-2004
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
1/30/2023 2:09:10 PM
Creation date
6/3/2020 9:43:33 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
1995-2004
RECORD_ID
PR0231070
PE
2351
FACILITY_ID
FA0006439
FACILITY_NAME
COUNTRY CLUB MOBIL CIRCLE K
STREET_NUMBER
2575
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
CURRENT_STATUS
01
SITE_LOCATION
2575 COUNTRY CLUB BLVD
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2351_PR0231070_2575 COUNTRY CLUB_1995-2004.tif
Tags
EHD - Public
Jump to thumbnail
< previous set
next set >
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
431
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
INSTRUCTIONS FOR CALF "NIC FORM T."INK INSTALLAON CERTIFICATION <br /> GENERAL INSTRUCTIONS <br /> 1. Each tank system musi be In compliance with the federal and state technical <br /> standards, contained ir! law and regulations, for tank and piping installation. <br /> 2. This certification shall be completed by either the UST owner or representative. <br /> ?. One certification is required for each tank system. This farm shall be used to <br /> make the required certification. <br /> 4. Please type'or print clearly all requested information (for printing, phase use a <br /> hard point writing instrument). <br /> 5. Submit the completed cei tification to the appropriate Local Implementing Agency. <br /> 1. INSTALLATION: MARK ALL OF THE ITEMS THAT APPLY TO INDICATE THAT THE <br /> INSTALLATION REQUIREMENTS ARE MET. <br /> 11. OATH: THE TANK OWNER OR AGENT SHALL CERTIFY, BY SIGNING THE <br /> CERTIFICATION, THAT THE INFORMATION PROVIDED IS TRUE AND <br /> CORRECT. THE PERSON'S NAME SHOULD BE PRINTED UNDER THE. <br /> SIGNATURE. <br /> III <br /> _ <br />
The URL can be used to link to this page
Your browser does not support the video tag.