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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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PR0231223
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
3/22/2022 11:19:04 AM
Creation date
6/9/2021 2:58:12 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0231223
PE
2361
FACILITY_ID
FA0002324
FACILITY_NAME
PACIFIC SERVICE STATION
STREET_NUMBER
6131
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
09746418
CURRENT_STATUS
01
SITE_LOCATION
6131 PACIFIC AVE
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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i <br /> UNDERGROUND STORAGE TANK (UST) <br /> OWNER 1 OPERATOR AGREEMENT <br /> UST OB2jF' <br /> As the o4ner of the underground storage tanks,I, MiLw�w� ZLOgii <br /> Ou certify <br /> (OWNER'S NkMFY <br /> that has been provided a copy of the monitoring and <br /> OPERATOR'S NAME) <br /> reporting requirements contained in Title 23,of the California Code of Regulations. <br /> 1; [,k I also certify that9-,6h,2 has been <br /> (O�VN R'S NAME (OPERATOR'S A,ME) <br /> provided a copy of the penalties for noncompliance as specified.in Section 25299, <br /> chapter 6.7, of the California Health and Safety Code. <br /> SIGNAT DATE: �- <br /> PRINT N _)4t,, <br /> UST OPE 4-ATOR: <br /> As opera�or f the underground storage tanks, I hereby certify that I understand the <br /> monitoring a d reporting requirements contained in Title 23, of the California Code <br /> of Regulatio s and 1 have received a copy of Section 25299,Chapter 6.7,of the <br /> California H alth and fety Code. <br /> SIGNAT DATE: , IZZ� 'zI <br /> PRINT NAME: L,c <br /> DBA NAME r 9At �r c- <br /> OPERATO NAME: <br /> LOCATI N <br /> 7!5!07 <br /> I <br />
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