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COMPLIANCE INFO_2023
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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REYNOLDS RANCH
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2300 - Underground Storage Tank Program
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PR0535432
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COMPLIANCE INFO_2023
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Entry Properties
Last modified
1/18/2024 2:54:38 PM
Creation date
5/5/2023 2:53:35 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2023
RECORD_ID
PR0535432
PE
2351
FACILITY_ID
FA0020431
FACILITY_NAME
COSTCO WHOLESALE #1091
STREET_NUMBER
2680
STREET_NAME
REYNOLDS RANCH
STREET_TYPE
PKWY
City
LODI
Zip
95240
CURRENT_STATUS
01
SITE_LOCATION
2680 REYNOLDS RANCH PKWY
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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ULT AZOLoGA9058 <br /> Manufacturer's AM rmative Statement of Compatibility <br /> (As required by California Code of Regulations section 2631 (k)) <br /> Asrequired by Federal Re ula#ion CFR Title 40 , Chapter 9 , Subcha ter I . Part 280 . 32 b 91 ii <br /> Supporting <br /> Component Current unique Test Data & <br /> Manufacturers) UL Years of Identifiers for Blend <br /> ( including prior Model Type Sizes Documents <br /> marketed names) (i.e. pipe: Standard Manufacture Field Evaluation Concentration Attachedtank, etc. ) Listing (i .e. color, material) Yes/No <br /> Petro Clear 40530P Filter VXYV2 Red Color NA ' NO <br /> Petro Clear 15N 'I - 12 Adapter Black Color NA NO <br /> l <br /> l <br /> -FOi'Unksgantt ptpiiig please list drily double Wali products (insert a company logo below if available) <br /> - Manufacturer: Champion Laboratories, Inc. <br /> Corporate: Champion Laboratories, Inc. <br /> Headquarters: <br /> Addre$S: 200 S 41hSt. Albion, IL -62806 <br /> Phone: (618) 445-6011 <br /> Email: OKris_stanhope&hamplabs corrin <br /> I declare, to the best of my knowledge and belief, that this afFirrimative statement of compatibility and the information contained herein is true , <br /> correct, and complete. <br /> Kris Stanhope Engineering Design Manager <br /> VtName Title <br /> �Ijo <br /> ZQ 13 <br /> Manufacturer' s Authorized Signature Date <br /> a rnnnn <br />
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