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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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2680
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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
12/17/2025 2:24:05 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 - UST FACILITY - 2481 COMPLIANT
FACILITY_ID
FA0020431
FACILITY_NAME
COSTCO WHOLESALE #1091
STREET_NUMBER
2680
STREET_NAME
REYNOLDS RANCH
STREET_TYPE
PKWY
City
LODI
Zip
95240
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\kblackwell
Supplemental fields
Site Address
2680 REYNOLDS RANCH PKWY LODI 95240
Tags
EHD - Public
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U LTRAZOL®GA9058 <br />Manufacturer's Affirmative Statement of Compatibility <br />(As required by California Code of Regulations section 2631(k)) <br />As required <br />by Federal Re ulation CFR <br />Title 40, -Chapter 1, Subchapter 1, Part 280.32 b 91 ii <br />Manufacturer(s) <br />(including prior Model <br />marketed names) <br />Component <br />p <br />Type <br />(i.e. pipe, <br />tank, etc. <br />Current <br />UL <br />Standard <br />Listing <br />Unique <br />Years of Sizes Identifiers for <br />Manufacture Field Evaluation <br />(i.e. color, material) <br />Blend <br />Concentration <br />Supporting <br />Test Data & <br />Documents <br />Attached <br />(Ye /No) <br />Petro Clear 40530P <br />Filter <br />VXYV2 <br />Red Calor <br />NA <br />NO <br />Petro Clear .75N1-12 <br />Adapter <br />= <br />Black Color <br />NA <br />NO <br />n <br />I declare, to the best of my knowledge and belief, that this <br />affirmative statement of compatibility and the information contained herMn <br />i.,true, <br />correct, and complete. <br />Kris Stanhope <br />Engineering Design Manager <br />Title <br />Pr' <br />t Name <br />For tanks and piping please list only double wall products <br />(insert a company logo below it available) <br />Manufacturer: Champion Laboratories, Inc. <br />Corporate: Champion Laboratories, Inc. <br />I <br />Headquarters: <br />Address: 200 S 41 St. Albion, IL 62806 <br />Phone: (618) 445-6011 <br />= <br />c <br />Email: Kris.stanhope@champlabs.com <br />n <br />I declare, to the best of my knowledge and belief, that this <br />affirmative statement of compatibility and the information contained herMn <br />i.,true, <br />correct, and complete. <br />Kris Stanhope <br />Engineering Design Manager <br />Title <br />Pr' <br />t Name <br />Manufacturer's Authorized Signature <br />2/lslzo23 <br />Date <br />
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