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COMPLIANCE INFO_2005-2008
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2300 - Underground Storage Tank Program
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PR0231897
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COMPLIANCE INFO_2005-2008
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Last modified
2/15/2024 1:53:27 PM
Creation date
6/3/2020 9:54:36 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2005-2008
RECORD_ID
PR0231897
PE
2361
FACILITY_ID
FA0006443
FACILITY_NAME
Tracy Texaco
STREET_NUMBER
2375
Direction
N
STREET_NAME
TRACY
STREET_TYPE
BLVD
City
TRACY
Zip
95376
APN
23207003
CURRENT_STATUS
01
SITE_LOCATION
2375 N TRACY BLVD
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231897_2375 N TRACY_2005-2008.tif
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EHD - Public
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Owner Staternerloof Designated Underground Stog? Tank (UST) Operator <br /> and Unders ding of and Compliance with Uequirements <br /> Facility Name: BP 02093 Facility ID: 02093 <br /> Facility Address: 3425 TRACY BLVD Reason for Submitting this Form(Check One) <br /> TRACY,CA 95376 ■ Change of Designated Operator <br /> Facility Phone#: 2098351605 ❑ Updated Certificate Expiration Date <br /> Designated UST Operator(s) for this Facility <br /> PRIMARY <br /> Designated Operator's Name: Brian Hernandez Relation to the UST Facility(Check One) <br /> Business Name(If different from above): Belshire Environmental Serives, Inc. ❑ Owner ❑ Operator ❑ Employee <br /> Designated Operator's Phone#: (949)460-5200 ❑ Service Technician ■ Third-Party <br /> International Code Council Certification#: 5308636-UC Expiration Date: 4/6/2009 <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): referto 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 <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 0 Third-Party <br /> International Code Council Certification* refer to backup document Expiration Date: refer to backup document <br /> I 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): Chris Moul <br /> Signature of Tank Owner: <br /> Date: 9/26/2008 Owner's Phone #: (714) 690-2349 <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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