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COMPLIANCE INFO_1989-2005
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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PR0232397
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COMPLIANCE INFO_1989-2005
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Last modified
10/12/2023 2:46:38 PM
Creation date
6/3/2020 9:56:43 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
1989-2005
RECORD_ID
PR0232397
PE
2361
FACILITY_ID
FA0003978
FACILITY_NAME
KAISER FOUNDATION - MANTECA
STREET_NUMBER
1777
Direction
W
STREET_NAME
YOSEMITE
STREET_TYPE
AVE
City
MANTECA
Zip
95337
APN
20018034
CURRENT_STATUS
01
SITE_LOCATION
1777 W YOSEMITE AVE
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0232397_1777 W YOSEMITE_1989-2005.tif
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EHD - Public
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INSTRUCTIONS FOR COMPLETING FORM °C": TANK Its-31ALLATION CERTIFICATION <br /> GENERAL INSTRUCTIONS <br /> 1. Each tank system must `'e in compliance v.s;ih 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 e'€:her the UST owner or representative. <br /> 3. One certification is required for each tamp ny%Pm, This farm shall be used to <br /> make the required certification. <br /> 4. Please type or print nli :elation {for printing, please use a <br /> hard point writing instrumenr6. <br /> 5. Submit the completed ceilitication 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 /> II. 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 /> i <br />
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