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COMPLIANCE INFO_2021
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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PR0231866
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
3/3/2021 9:43:15 AM
Creation date
1/19/2021 9:28:06 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0231866
PE
2361
FACILITY_ID
FA0003957
FACILITY_NAME
AT&T California - UE020
STREET_NUMBER
124
Direction
W
STREET_NAME
ELM
STREET_TYPE
St
City
Lodi
Zip
95240
CURRENT_STATUS
01
SITE_LOCATION
124 W Elm St
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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Underground Storage Tank <br /> Designated UST Operator Visual Inspection Report <br /> 5. OWNER/OPERATOR DESCRIPTION OF FOLLOW-UP ACTION <br /> Number the follow up actions to correspond to appropriate compliance issues from Section 3. <br /> 6. OWNER / OPERATOR ACKNOWLEDGEMENT OF INSPECTION RESULTS <br /> I have reviewed the results of the designated UST operator inspection report and provided a <br /> description of the action(s) taken or to be taken to correct any compliance issues discovered. <br /> Name of UST Owner/ Operator (print) <br /> UST Owner/Operator Signature Date Signed <br /> Alton "Duke" L Thomson I I I Digitally signed by Alton"Duke"L Thomson III <br /> Date:2021.01.20 16:44:41 -06'00' <br /> 7. INSPECTION HISTORY <br /> Has each follow-up action of Section 3 from the previous Designated UST Yes No NA <br /> Operator Inspection Report been completed appropriately? ❑ 8 ❑ <br /> (Attach documentation verifying appropriate service to this report.) <br /> 8. RELEASE DETECTION ALARM HISTORY <br /> Attach a copy of the alarm history report/log to this report. Yes No NA <br /> Is the monitoring system powered on and in proper operating mode? ❑� ❑ <br /> Has each alarm since the previous inspection been responded to appropriately? ❑ ❑ ❑ <br /> (Attach documentation verifying appropriate service to this report.) <br /> Have all containment sumps, that have had an alarm since the previous <br /> designated UST operator inspection report, been responded to by a qualified ❑ ❑ ❑✓ <br /> service technician? <br /> All answers marked "No"must be described by the designated UST operator in Section 3. <br /> Page 2 of 4 <br />
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