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COMPLIANCE INFO_1996-2002
Environmental Health - Public
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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_1996-2002
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Last modified
6/10/2020 4:13:37 AM
Creation date
6/3/2020 9:52:15 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
1996-2002
RECORD_ID
PR0231764
PE
2361
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
01
SITE_LOCATION
5611 E WATERLOO RD
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231764_5611 E WATERLOO_1996-2002.tif
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EHD - Public
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COMPLEIE THIS SECTION • ON DELIVEPY <br /> ■ Compl e Mc <br /> mplete A. Signature <br /> item 4' Tdd <br /> ei� red. ❑Agent <br /> Print ydr s�gg reverse X ❑Addressee <br /> so that e cardto you. B. Received by(Printed ame) C. Dat of 96livery <br /> ■ Attach this card to the back of the mailpiece, <br /> or on the front if space permits. All* P Z4 <br /> D. Is delivery address d' erent from item 1? 0 Y s <br /> 1. Article Addressed to: If YES,enter delivery address below: ❑No <br /> WATERLOO GAS & LIQUOR <br /> MART <br /> 5611 WATERLOO RD 3. Service Type <br /> STOCKTON CA 95215 XCertified Mail ❑Express Mail <br /> ❑Registered ❑Return Receipt for Merchandise <br /> ❑Insured Mail ❑C.O.D. <br /> 4. Restricted Delivery?(Extra Fee) ❑Yes <br /> 2. Article Number 7004 2510 0003 3789 1877 <br /> (transfer from service label) <br /> PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 <br />
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