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COMPLIANCE INFO_2023
Environmental Health - Public
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EHD Program Facility Records by Street Name
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J
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JACK TONE
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704
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2300 - Underground Storage Tank Program
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PR0547997
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COMPLIANCE INFO_2023
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Entry Properties
Last modified
1/31/2024 1:13:25 PM
Creation date
6/26/2023 11:06:39 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2023
RECORD_ID
PR0547997
PE
2351
FACILITY_ID
FA0027375
FACILITY_NAME
GRAPPA MARKET SHELL
STREET_NUMBER
704
Direction
N
STREET_NAME
JACK TONE
STREET_TYPE
RD
City
RIPON
Zip
95366
APN
25966077
CURRENT_STATUS
03
SITE_LOCATION
704 N JACK TONE RD
P_LOCATION
05
P_DISTRICT
005
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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Appendix IX <br /> Underground Storage Tank <br /> Overfill Prevention Equipment Inspection Report Form <br /> TYPE OF ACTION Installation ❑ Repair 36 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Inspection Date <br /> �.�3 - z 3 <br /> Facility Name <br /> C C K- <br /> Facility Address City ZIP Code <br /> — 710 9t+ e t) Cr.N C <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Inspection Phone <br /> LC SERVICES (559) 444-1730 <br /> Mailing Address <br /> 3887 N VALENTINE <br /> Service Technician Performing Inspection <br /> Contractor/Tank Tester License Number <br /> 779267 <br /> ICC Number Expiration Date <br /> 91-4L4 -79C <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> FFS PRO EVR VR-101 f -� 3 J-0,V) 9 -zc)c 3 <br /> OPW <br /> 4. INSPECTION PROCEDURES INFORMATION <br /> Inspection Procedures Used Components Inspected <br /> NO r �1�ss' <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING INSPECTION <br /> 1 hereby certify that the OPE was inspected in accordance with California Code of <br /> Regulations, title 23, division 3, chapter 16, section 2637.2; that required supporting <br /> documentation is attached; and all information contained herein is accurate. 1 understand <br /> that test procedures shall be made available upon request by the governing authority. <br /> Service Technician Signature::� Date Total # of Pages� '--2-- <br /> f — 3 .- L3 2 <br /> v .101 <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council, OPE = Overfill Prevention Equipment <br /> Page 1 of 2 <br />
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