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INSTALL_2022
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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PR0547762
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INSTALL_2022
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Last modified
8/26/2025 10:48:13 AM
Creation date
7/6/2022 9:54:17 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
INSTALL
FileName_PostFix
2022
RECORD_ID
PR0547762
PE
2351
FACILITY_ID
FA0027204
FACILITY_NAME
SAFEWAY FUEL CENTER #0055
STREET_NUMBER
19533
Direction
S
STREET_NAME
MOUNTAIN HOUSE
STREET_TYPE
PKWY
City
MOUNTAIN HOUSE
Zip
95391
CURRENT_STATUS
01
SITE_LOCATION
19533 S MOUNTAIN HOUSE PKWY
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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i t <br /> TANK INSTALLATION CHECKLIST <br /> 4 <br /> ,,.,,.,,77 -- <br /> - <br /> t, <br /> 4iF; <br /> Qr <br /> s <br /> .. - <br /> .,.: . <br /> \je Note any variations and/or deviations from <br /> C.rj i <br /> instructions(and attach written authorizations): <br /> . <br /> xa <br /> 40 <br /> 1 _ <br /> VERI" <br /> CONTRAaOR TANK OWN ERIREPRESENTATIVE <br /> I verify that this information is a true record of the installation of the tanks I verify that this information is a true record of the installation of the tanks <br /> listed here. listed here,and that I have received a copy of the Installation Manual <br /> and this Tank Installation Checklist. <br /> Name: �= Name: k==0/t1W5 <br /> Telephone: -. �- Tele ne: ?D <br /> rnaol: E fl: r9-Voo 642Z1 <br /> 1 m <br /> Address: eAd dress: <br /> Signature: y- i nature: <br /> Date: ate: <br /> TO INSTALLER:After tank installation,deliverthe Installation Manual with the completed Tank Installation Checklistto the tank owner.Retain a copy of <br /> each for your records. <br /> 4 :After installation,retain the limited warranty,the Installation Manual and completed Tank Installation Checklist forfuture reference and to <br /> facilitate any warranty claim. <br /> EMPINVEL ILA, <br /> x rltj%E S <br /> ,� <br /> BY SHAWCOR <br />
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