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COMPLIANCE INFO_2002 - 2010
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0231223
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COMPLIANCE INFO_2002 - 2010
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Entry Properties
Last modified
12/16/2019 3:26:44 PM
Creation date
12/16/2019 1:48:18 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2002 - 2010
RECORD_ID
PR0231223
PE
2361
FACILITY_ID
FA0002324
FACILITY_NAME
Pacific Service Station
STREET_NUMBER
6131
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
09746418
CURRENT_STATUS
01
SITE_LOCATION
6131 PACIFIC AVE
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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KBlackwell
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EHD - Public
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Mar 16 07 12: 01p Elites Iv Contractors Inc 209461Q342 p. l <br /> TANKS ' <br /> UNDERGROUND STORAGE TANKS -INSTALLATION. <br /> CERTIFICATE OF COMPLIANCE <br /> ii GCI�f�U• i ��/ i <br /> page per tank) ; <br /> Pogo _ d <br /> L FACILITY IDENTIFICATION <br /> Be75 KSS NAPE(Same as FAUM N"E or MA- Aa) <br /> -( :n 40�14�rl So km,-� <br /> ADDRESS fror boli v my) <br /> FNCriITY%D o n t 1AW108 <br /> L INSTALLATION <br /> / {Check anthat apply) <br /> 4 / The instaBer has been trained and certified by the tank and piling manufacturers. <br /> ❑✓ The instalamon has been inspected and certified by a regrdered professional engineer having education and <br /> e4xrience wdh underground storage tank insta ions <br /> L The instafiaSon has been inspected and approved by Ute Unified Program Agency_ <br /> / Ak work bsa ted on the rnanufac h rets anstaffation checklist has been completed <br /> }Ilr /The installer has been certified or licensed by the Contractors'State License Board. <br /> • 0- The underground storage tank,any Perry Pig,and teary containment was arstaled according to f <br /> aWbcable wkrntary consensus standards and written marxufaCbuer's itstal ation procedures Description of <br /> work being certified: <br /> H.TANK OWNERIAGENT SIGNATUR>r <br /> 1 cvAtTsrae.afedu�on po.a.a n.a..s Mr ae acanOs b aae beat of my ho.rdp� i <br /> JGMI - TANK OYI?! DAM 1 <br /> HME OF TANK OwrNDi�AGea&-0 I LE OFTAW OVA*-PJAGO" <br /> i <br /> i <br /> I <br /> i <br />
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