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COMPLIANCE INFO_1989-2001
EnvironmentalHealth
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BENJAMIN HOLT
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2300 - Underground Storage Tank Program
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PR0231952
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COMPLIANCE INFO_1989-2001
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Last modified
9/13/2022 2:55:50 PM
Creation date
6/23/2020 6:37:49 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
1989-2001
RECORD_ID
PR0231952
PE
2351
FACILITY_ID
FA0003712
FACILITY_NAME
CHEVRON STATION #94275*
STREET_NUMBER
2905
Direction
W
STREET_NAME
BENJAMIN HOLT
STREET_TYPE
DR
City
STOCKTON
Zip
95207
APN
09760004
CURRENT_STATUS
01
SITE_LOCATION
2905 W BENJAMIN HOLT DR
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2351_PR0231952_2905 W BENJAMIN HOLT_1989-2001.tif
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EHD - Public
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} <br /> INSTRUCTIONS FOR CO LETINC FORM "C": TANK INSTALLATI4JN CERTIFICATION <br /> Y$ # <br /> !NST7'!7 1(�+ <br /> be in .*com ajance.with the federal and state technical <br /> law and-regulations., for tank and piping installation. <br /> 1. �s certification hail be completed by either the UST owner or representative. <br /> 3, _"- iicalio Rs re�.iuired for each tank system. This form shall he used to <br /> mE, required certification. <br /> 4. Please type or print clearly all rei queued Information for prinfin , please use a <br /> Pard ?"oiilftri'i'n dwtl",ur entf. <br /> 5. Submit the completed certification to the apron ria l (gal irnplementing Agency. <br /> 1. INSTALLATION: MARK ALL OF THE ITEIi S THAT THA17 TIME <br /> INSTALL.ATiON REQUIREMENTS ARE ME ,_ <br /> I1. OATH: THE TANK OWNER OR AGEtsT. SHALL. CERTIFY", BY SIGNING THE <br /> CERTIFICATION, THAT THE INFORMATION PROVIDED IS TRUE AND <br /> L ORREC'7. THE PERSON'S NAME SHOULD RE PRINTED UNDER THE <br /> SIGNATURE. <br />
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