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COMPLIANCE INFO_1985-1998
Environmental Health - Public
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EHD Program Facility Records by Street Name
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KETTLEMAN
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1301
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2300 - Underground Storage Tank Program
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PR0231342
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COMPLIANCE INFO_1985-1998
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Last modified
11/4/2021 2:57:00 PM
Creation date
6/3/2020 9:46:52 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
1985-1998
RECORD_ID
PR0231342
PE
2361
FACILITY_ID
FA0000392
FACILITY_NAME
FLAMES LIQUOR
STREET_NUMBER
1301
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95242
APN
03104030
CURRENT_STATUS
01
SITE_LOCATION
1301 W KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231342_1301 W KETTLEMAN_1985-1998.tif
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EHD - Public
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0 • <br />INSTRUCTIONS FOR COMPLETING FORM "C": TANK INSTALLATION CERTIFICATION <br />GENERAL INSTRUCTIONS <br />1. Each tank system must be In compliance with the federal and state technical <br />standards, contained In law and regulations, for tank and piping Installation. <br />2. This certification shall be completed by either the UST owner or representative. <br />3. One certification Is required for each tank system. This form shall be :used to <br />make the required certification. <br />4. Please type or print clearly all requested information (for printing, please use a <br />hard point writing Instrument). <br />5. Submit the completed certification to the appropriate Local Implementing Agency. <br />1. INSTALLATION: MARK ALL OF THE ITEMS THAT APPLY TO INDICATE THAT THE <br />INSTALLATION REQUIREMENTS ARE MET. <br />It. OATH: THE TANK OWNER OR AGENT SHALL CERTIFY, BY SIGNING THE <br />CERTIFICATION, THAT THE INFORMATION PROVIDED IS TRUE AND <br />CORRECT. THE PERSON'S NAME SHOULD BE PRINTED UNDER THE <br />SIGNATURE. <br />kr <br />
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