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COMPLIANCE INFO_PRE 2019
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2231-2238 – Tiered Permitting Program
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PR0506935
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COMPLIANCE INFO_PRE 2019
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Last modified
8/31/2020 2:53:59 PM
Creation date
7/30/2020 7:44:27 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2231-2238 – Tiered Permitting Program
File Section
COMPLIANCE INFO
FileName_PostFix
PRE 2019
RECORD_ID
PR0506935
PE
2233
FACILITY_ID
FA0006691
FACILITY_NAME
Walmart # 1789
STREET_NUMBER
2350
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
Ln
City
Lodi
Zip
95242
APN
058-140-35
CURRENT_STATUS
02
SITE_LOCATION
2350 W Kettleman Ln
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\gmartinez
Supplemental fields
FilePath
\MIGRATIONS\Tiered Permitting\K\KETTLEMAN\2350\PR0506935\COMPLIANCE INFO PRE 2016.PDF
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EHD - Public
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EPA M NUMBER CAL9_23424231 Page 2 ofe o <br /> III. RADIOACTIVE MATERIALS OR WASTE M <br /> YES NO . <br /> ❑ ® Does the facility use. store or treat radioactive mut mals or radioactive waste? <br /> 1r. TYPE OF COMPANY:-STANDARD WDUSTRIAL CLASSIFICATION (SIC) CODE: <br /> Use either one or twn SIC oades (a four aigit number)that bast describe your company's pnxhgls, services. or gndustrial activity. <br /> Example.. zW r x zu rndtemiallagohderrra <br /> C First: 7 3 8 4. Photo€i n�i s h i n g Lab Second: <br /> q <br /> V. PRIOR PERMIT STATUS: Check yrs or no to each question: <br /> IE <br />. YES No �I <br /> ❑ ❑ 1. Did you file a PBR Notice of Intent to Operate(DISC Form 9462) in 1992 for this location? <br /> k ,; <br />` ❑ ❑ 2. Do you now have or have you ever held a state or federal hazardous waste facility full Permit or interim <br /> status for any of these treatment units? <br /> ❑ ❑ 3. Do you now have or have you ever held a state or federal full permit or interim status for any other <br /> II <br /> hazardous waste activities at this location? <br /> I ❑ ❑ 4. Have you ever held a variance issued by the Department of Toxic Substances Control for the treatment You <br /> are now notifying for at this location? <br /> ❑ ❑ 5. Has this location ever been inspected by the state or any local agency as a hazardous waste genera=? <br /> VI. PRIOR ENFORCEMENT FIISPORY: Not requirad franc gemwo n only natifyrtgg as cewdidOnaliy or ssly a <br />€ cattimer dal laundry. <br /> YES NO <br /> ❑ ❑ Within the last three years. has'this facility been the subject of any convictions. judgments. settlements, or finz <br /> E orders resulting from an action'�by any local, state. or federal environmental, hazardous waste, or Public healtl. <br /> enforcement agency? `k <br /> (For the purposes of this form a notice of violation does not constitute an order and need not be reported unl= <br /> it was not corrected and became a final order.) <br /> I' ❑ If you answered Yes, check this boa and attach a listing of convictions.judgments. mttlements. or orders ma., <br /> copy of the cover sheet from 'each document. (See the Instrncctions for more information) <br /> VII. ATTACIIMENNTS: Auadunexts ane not neguirad for C rmnercs d Iaun&Y fa0h las <br /> N <br /> ❑ 1. A plot planimap detailing the l.iocstion(s) of the covered unit(s) in relation to the facility b0undaries- <br /> [3 2. ' A unit specific notification for& for each unit to be covered at this location. <br /> .. ,, Page <br /> DISC 1772(1195) <br />
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