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COMPLIANCE INFO_1998-2007
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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PR0231488
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COMPLIANCE INFO_1998-2007
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Last modified
8/12/2021 10:51:17 AM
Creation date
6/23/2020 6:49:22 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
1998-2007
RECORD_ID
PR0231488
PE
2361
FACILITY_ID
FA0003910
FACILITY_NAME
H&M - BW #98
STREET_NUMBER
2501
STREET_NAME
JACKSON
STREET_TYPE
AVE
City
ESCALON
Zip
95320
CURRENT_STATUS
01
SITE_LOCATION
2501 JACKSON AVE
P_LOCATION
06
P_DISTRICT
005
QC Status
Approved
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SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231488_2501 JACKSON_1998-2007.tif
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EHD - Public
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08/16/2007 06'.37 FAX BOYETT PETROLEUM 10002/011 <br />SAN JOAQUINCOUNTY <br />TAL FIFALI'll DI-TARINLNT <br />I�NVJK(JNMEN <br />304 Flast Weber Aycritic, 3 )" Floor, Stockton, C " 'A 95202-1708 <br />7'elcphone. (209) 468,34'20 %14r, (209) 468-3433 We& q <br />%%�v�jgLiv.grL_,/.[id <br />RETURN TO COMPLIAN(l, CERTIFICATION <br />Any MINOR violations noted in the "Notice to Comply" in the anached inspection report niust be <br />corrected within 30 daL of receipt of this inspection, This certification f6rm must be suOrnitted to the <br />Environmental ReaFt <br />'h Department (IJ -11)) address at tile top of'this florm within 35 days ofreceipf ofthe <br />inspection report. <br />All coge.c0ons to -other violations noted in file attached Inspection Report (IR) or Continuation Form. or <br />disputes to any violations, are to be subi-nitted using this certification and returned to EHD within 00 days <br />Liriless otherwise specified in the IR, <br />For this certification to beCOMPICtC the operator of the site must include: <br />• A statement documenting what corrective actions were taken or will be taken fir each violation <br />• Copies of sample results/iiianiti=si.s/iriiniiig records/other appropriate papenvork.and/or photos <br />verifying corrections <br />• Operator's certification <br />Y <br />Inspection DaLe:. iA <br />InSpeCLed By' <br />Facility Address:1 H�,cle I'j A �i EPA 11.)I/: C. <br />. ............... <br />I certify tinder penalty of" law that; <br />1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br />inspection date. <br />2. 1 have personally examined thc hollowing documentation submitted as proof of compliance FOR <br />EACH VIOLA"HON and I believe the inflormation to he true. accurate, and complete: <br />Photos --ALPaperwork . .............. Statement <br />3. 1 ane authorized to submit this certification on behal-l'of the Respondeol, <br />4. 1 am aware that thorc are significant. penalties for submitting false informat k.)n. including tile <br />possibility of a fine and/or irriprisonnicrit for known violations. (11SC 25191) <br />Nam: r?-(-')Vf6A <br />Signature, <br />FFID 22-02-00-5 Rev 12-04 <br />m c- Ni ik: V <br />V, <br />Date: L) <br />
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