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COMPLIANCE INFO_2021
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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EL DORADO
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1901
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2300 - Underground Storage Tank Program
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PR0231092
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COMPLIANCE INFO_2021
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Last modified
6/16/2022 8:19:52 AM
Creation date
1/19/2021 7:43:53 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0231092
PE
2361
FACILITY_ID
FA0001946
FACILITY_NAME
El Dorado Food Mart
STREET_NUMBER
1901
Direction
S
STREET_NAME
EL DORADO
STREET_TYPE
ST
City
STOCKTON
Zip
95206
APN
16508019
CURRENT_STATUS
01
SITE_LOCATION
1901 S EL DORADO ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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AN ' <br /> 't � (� ( Environmental Health Department <br /> O U N T Y - .- -. <br /> T° SYSTEM RETROFIT OR REPAIR <br /> ( Submit minimum of 3 sets of plans & applications as originals will be retained by EHD ) <br /> 1 . Site map enclosed ? YES [ ] NO [x] <br /> Z Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer training <br /> certificates for each person installing or testing any component that is repaired or replaced . Ensure a copy of <br /> the "Site Health and Safety Plan" is available on the jobsite as required by Title 8 . <br /> 3 . Detailed description of work to be completed . List components to be repaired or replaced and attach a <br /> diagram drawn to scale showing location of repairs and/or replacements . If repairing a component, describe <br /> how this will be done . ( If adding piping, UDC 's , or other UST equipment, or performing tank top upgrade, <br /> use the UST Installation Application pages 4=8 as necessary for a timely plan review) : <br /> Replace existing Dispensers Wth New Dispensers. <br /> 4 . List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval ) : <br /> (2) Gilbarco Encore 700S Dispensers <br /> (2) Bravo Conversion Frames <br /> (2) Bravo Deflector plates <br /> 5 . Decontamination Procedures : <br /> a . Will piping be decontaminated prior to removal ? YES [ ] NO [ ] <br /> b . Identify contractor performing decontamination : <br /> Name Phone ( ) <br /> Address City Zip <br /> f <br /> 3of6 <br />
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