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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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PR0231547
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COMPLIANCE INFO_2021
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Last modified
12/28/2021 10:51:43 AM
Creation date
5/5/2021 2:29:51 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0231547
PE
2361
FACILITY_ID
FA0003848
FACILITY_NAME
Verizon Business: KINGCA
STREET_NUMBER
13850
Direction
N
STREET_NAME
DE VRIES
STREET_TYPE
RD
City
LODI
Zip
95242
APN
05524018
CURRENT_STATUS
01
SITE_LOCATION
13850 N DE VRIES RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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13850 N De Vries, Lodi, CA 95240 PR0231547 <br />08/17/2021 Program: UST <br />PHOTO 3: <br />Report signed by owner/operator on 01/11/2021 <br />PW <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 discoverec <br />Name of UST Owner / Operator (print) <br />Stephen G. Wiedemann <br />UST Owner/Operatorr Signature Date Signed <br />211011 b1Y1 ��SG�-0 tlemann <br />M21011112-- <br />7. <br />7. INSPECTION HISTORY <br />I <br />' Has each follow-up action of Section 3 from the previous Designated UST <br />Yes No <br />Operator Inspection Report been completed appropriately? <br />1 Attach d01 <br />ocumentation veri in appropriate service to this re ort. <br />8. RELEASE DETECTION ALARM HISTORY <br />Attach a copy of the alarm history reportliog to this report. <br />Yes No <br />Is the monitoring system powered on and in proper operating mode? <br />® ❑ <br />Has each alarm since the previous inspection been responded to appropriately? <br />❑ ❑ <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 />❑ ❑ <br />service technician? <br />All answers marked "No" must be described by the designated UST operator in Section 3. <br />IT FAULT <br />__ARA <br />C . FAULT <br />Page 2 of 4 <br />KJO <br />VICKY VANG-LEE, EHS Page 3 of 5 <br />
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