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COMPLIANCE INFO_1998-2002
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0231074
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COMPLIANCE INFO_1998-2002
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Last modified
3/1/2023 9:51:39 AM
Creation date
6/23/2020 6:40:56 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
1998-2002
RECORD_ID
PR0231074
PE
2361
FACILITY_ID
FA0002541
FACILITY_NAME
7-ELEVEN INC #20632
STREET_NUMBER
4627
STREET_NAME
DA VINCI
STREET_TYPE
DR
City
STOCKTON
Zip
95207
APN
11002003
CURRENT_STATUS
01
SITE_LOCATION
4627 DA VINCI DR
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
Scanner
SJGOV\rtan
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FilePath
\MIGRATIONS\UST\UST_2361_PR0231074_4627 DA VINCI_1998-2002.tif
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EHD - Public
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INSTRUCTIONS FOR COh'EFI..ETING 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 regulatiors, for tank and piping installation:. <br /> 2. This certification shall be completed by erher 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. g <br /> 4. Please type or print clearly all requested i form( rr p nt n ,lease use a <br /> hard point writing instru alot). <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 /> 11. 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 />
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