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COMPLIANCE INFO_2023
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0231764
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COMPLIANCE INFO_2023
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Entry Properties
Last modified
12/17/2025 2:55:51 PM
Creation date
6/28/2023 4:23:32 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2023
RECORD_ID
PR0231764
PE
2361 - UST FACILITY
FACILITY_ID
FA0002160
FACILITY_NAME
BlackHawk Petroleum Inc.
STREET_NUMBER
5611
Direction
E
STREET_NAME
WATERLOO
STREET_TYPE
RD
City
STOCKTON
Zip
95215
APN
08710052
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\kblackwell
Supplemental fields
Site Address
5611 E WATERLOO RD STOCKTON 95215
Tags
EHD - Public
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G,NTRACTORS <br />State Lic. #1001331 <br />� , Or" <br />,` 5'205 <br />�" <br />6137 Fax (209) 461-6342 <br />�6r <br />;-0. 0 <br />FAC# <br />Work Order <br />DATE1t-®- z <br />Ref: = <br />JOB NAME <br />PUMP TEST HOSE N <br />UrOpn !'\ f r ,VtA t <br />JOB SITE <br />MONEY TOTAL <br />!M o y� , ✓� <br />TOTAL GALLONS <br />lry , F^ i �cn tc �1e Jr c��� . `O (= P ?� <br />`J -e -ed, <br />(4j Sc <br />1� <br />lJ✓�� cc e u S �0. <br />ORDERED BY <br />TOTALIZER BEFORE <br />Ui A r `?� <br />` t �l�u �_ �G�e >� <br />C%✓1 (( �� (N� <br />S+ ! vet +� L v V u �O �r,�P.'� <br />�^' Si - p�Pfw <br />TOTALIZER AFTER <br />DESCRIPTION OF WORK DONE <br />UrOpn !'\ f r ,VtA t <br />LVI,J� <br />!M o y� , ✓� <br />Ovi. W o S` 55J S <br />lry , F^ i �cn tc �1e Jr c��� . `O (= P ?� <br />`J -e -ed, <br />(4j Sc <br />1� <br />lJ✓�� cc e u S �0. <br />S-ewY F - <br />�✓1 o�t�/t� 4 u a y 1 -e , dU . kLl, �u i_ . <br />Ui A r `?� <br />` t �l�u �_ �G�e >� <br />C%✓1 (( �� (N� <br />S+ ! vet +� L v V u �O �r,�P.'� <br />�^' Si - p�Pfw <br />d),J �, SfrVk2�, "t SA(DL_') (ntoc_.> 0-,0t 'P!,'J <br />I HEREBY ACKNOWLEDGE COMPLETION OF THE ABOVE DESCRIBED WORK <br />SIGNATURE <br />MATERIAL AND LABOR <br />QTY I MATERIAL USED <br />,33 1put r <br />PRICE I AMOUNT I TECH I SITE IN I SITE OUT <br />AM AM <br />PM LJ ! JU PM <br />AM I AM <br />PM PM <br />AM AM <br />PM PM <br />AM AM <br />FM PM <br />AM AM <br />PM PM <br />TRAVEL TIMF <br />TOTAL MILAGE <br />WARRANTY WORK _YRS —,NO OT: ITS O <br />COMPLFm YES �O �AHARY _ PILECOPY <br />WHITE - OFFlCE CCWY <br />HRS I RATE I AMOUNT <br />__L_H TOTAL <br />PINK - CUSTOMER COPY <br />
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