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SR0082410
Environmental Health - Public
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EHD Program Facility Records by Street Name
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12 (STATE ROUTE 12)
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13550
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4200/4300 - Liquid Waste/Water Well Permits
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SR0082410
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Last modified
11/19/2024 3:48:04 PM
Creation date
9/3/2020 2:37:09 PM
Metadata
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Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0082410
PE
4231
FACILITY_NAME
13550 HWY 12
STREET_NUMBER
13550
Direction
W
STREET_NAME
STATE ROUTE 12
City
LODI
Zip
95242
APN
05502002
ENTERED_DATE
7/31/2020 12:00:00 AM
SITE_LOCATION
13550 W HWY 12
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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TSok
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EHD - Public
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APPENDIX E <br /> SITE SKETCH(Indicate specifics of tank installation.) ADDITIONAL NOTES <br /> Note any variations and/or deviations from <br /> instructions(and attach written authorizations): <br /> VERIFYING SIGNATURES <br /> CONTRACTOR TANK OWNER/REPRESENTATIVE <br /> I verify that this information is a true record of the installation I verify that this information is a true record of the installation of the <br /> of the tanks listed here. tanks listed here,and that I have received a copy of the Installation <br /> Manual and this Tank Installation Checklist. <br /> Name: Name: <br /> Telephone: Telephone: <br /> Email: Email: <br /> Address: Address: <br /> Signature: Signature: <br /> Date: Date: <br /> TO INSTALLER:After tank installation,deliver the Installation Manual with the completed Tank Installation Checklist to the tank owner.Retain a copy <br /> of each for your records. <br /> TO OWNER:After installation,retain the limited warranty,the Installation Manual and completed Tank Installation Checklist for future reference and <br /> to facilitate any warranty claim. <br /> ZCL � XERXESx 47 <br />
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