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COMPLIANCE INFO_2013-2018
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2300 - Underground Storage Tank Program
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PR0231074
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COMPLIANCE INFO_2013-2018
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Last modified
3/1/2023 11:27:36 AM
Creation date
6/23/2020 6:41:03 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2013-2018
RECORD_ID
PR0231074
PE
2361
FACILITY_ID
FA0002541
FACILITY_NAME
7-ELEVEN INC #20632
STREET_NUMBER
4627
STREET_NAME
DA VINCI
STREET_TYPE
DR
City
STOCKTON
Zip
95207
APN
11002003
CURRENT_STATUS
01
SITE_LOCATION
4627 DA VINCI DR
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231074_4627 DA VINCI_2013-2018.tif
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EHD - Public
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y, <br />""D <br />*RE <br />(' J� N, r O A Q �} I N Environmental Health Department <br />J! -i JU�1tJU (ii.0 2018. <br />—,--COUNTY— - <br />ENVIRONMENTAL HEALTH <br />pA TA4 <br />1. (a) Is the current certificate of worker's compens 1 ce on file? YE } NO ( j <br />(b) Does the contractor possess a "Hazardous Substance Removal Certification"? YEW NO I) <br />(c) Has everyone on site, including crane/backhoe operator, been certified to work on YESPd NO [ ) <br />hazardous waste sites in accordance with CCR Title 8? <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? YESX NO [ ) <br />3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Permit"? <br />N/A KV YES [ ] NO [ j If YES, Permit # <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NA[ J YES [ J NO <br />5. is there knowledge or evidence of leakage from the tank(s) and/or piping? (If yes, please explain) YES [ l NOVLI <br />6. if tank residual a fists, Identlly transoortinn azar ous waste hauler: '� )(� th 41- ( W It <br />nVfAi1+Q c1 L l <br />T Name Hauler Registration # <br />Address ` City t `WUWZip-- <br />Phone # <br />7. Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YES [)j NO[ J <br />b. Identify contractor performing decontamination: <br />Name t --C CVS <br />Address 34*4817 W tiq`4� .s'.1�g= City ]ac' Zip <br />Phone No.( <br />No.( <br />C. De§cribe rpethod to bp used for deco rntrninatign;_ <br />d. Describe how n sate material will be stored onsite Dnor to manifesting qff lte: <br />4C,4 <br />-- <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name _Hl f Hauler Registration # L� L 83a (. � <br />Address 2 '7 f I fl�,1''C Ce, 7 K - City G �4 +- Zip <br />Phone No. (9q ) o"9-7,0® <br />Permitted Dispo`s �I_Site £ 0 �p+ 6r 0 G <br />6 ® 13 3'E - <br />2b dQ {� OG`- OA. 0 <br />8. a. Describe the metho that will bettilize t k'yl.t.-Lbur a /or inert the tank <br />b. Ta !pin�i� auie//r. <br />Name <br />Address City Zip <br />Phone <br />Hauler Registration # (if hauled as hazardous) <br />il <br />Z5 - c 4 o (`a <br />Q q-LMbo-510D <br />t yt 3 <br />-X \ Z7,5 <br />81 <br />
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