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INSTALL 2019
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0543446
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INSTALL 2019
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Entry Properties
Last modified
9/3/2019 10:52:47 AM
Creation date
1/16/2019 2:16:41 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
INSTALL
FileName_PostFix
2019
RECORD_ID
PR0543446
PE
2351
FACILITY_ID
FA0024656
FACILITY_NAME
7-ELEVEN #38153
STREET_NUMBER
121
Direction
S
STREET_NAME
CENTER
STREET_TYPE
ST
City
STOCKTON
Zip
95202
CURRENT_STATUS
01
SITE_LOCATION
121 S CENTER ST
QC Status
Approved
Scanner
KBlackwell
Tags
EHD - Public
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APPENDIX E (Continued from Page 46) <br />y�� �� AQDITIONALNQTES �; ,z° <br />Note any variations and/or deviations from <br />instructions (and attach written authorizations): <br />` VERIFYINGSIGNATURES <br />CONTRACTOR <br />TANK OWNER/REPRESENTATIVE <br />I verify that this information is a true record of the installation <br />I verify that this information is a true record of the installation of the <br />of the tanks listed here. <br />tanks listed here, and that I have received a copy of the Installation <br />Manual and this Tank Installation Checklist. <br />Name: f�Li(7/✓ ��(/C/�/�Ir_Q/C <br />Name: <br />Telephone: �/%� �_ <br />— <br />Telephoner <br />Email: GV GLO��L�/�_ <br />Email: <br />Address: �� ��� <br />Address: <br />Signature: a4 <br />Signature: <br />Date: q— g ^ <br />Date: <br />TO INSTALLER: After tank installation, deliver the Installation Manual with the completed Tank Installation Checklist to the tank owner. Retain a copy <br />of each for your reco rds. <br />TO OWNER: After installation, retain the limited warranty, the Installation Manual and completed Tank Installation Checklist forfuture reference and <br />to facilitate any warranty claim. 1-1 <br />ZCL I XERXES® APPENDIX E 47 <br />
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