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COMPLIANCE INFO 2006 - 2012
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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DR MARTIN LUTHER KING JR
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701
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2300 - Underground Storage Tank Program
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PR0231059
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COMPLIANCE INFO 2006 - 2012
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Last modified
6/10/2019 3:50:24 PM
Creation date
11/16/2018 10:45:08 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2006 - 2012
RECORD_ID
PR0231059
PE
2361
FACILITY_ID
FA0002512
FACILITY_NAME
GSG GAS & MART
STREET_NUMBER
701
Direction
E
STREET_NAME
DR MARTIN LUTHER KING JR
STREET_TYPE
BLVD
City
STOCKTON
Zip
95206
APN
14734311
CURRENT_STATUS
01
SITE_LOCATION
701 E DR MARTIN LUTHER KING JR BLVD
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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KBlackwell
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EHD - Public
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AFFORDA-TE$T <br />416 2nd Street . Galt CA 95632 LINE & LEAK DETECTOR <br />(209) 744-0112 FAX (209) 744-0116 TEST REPORT <br />CONTRACTOR/ENGINEER <br />TEST DATE �, C, �e, L <br />SITE NAME ` t•.A_Pi'G�L r .v �C t'7_ "' i c�; ca <br />� �_ PHONE( <br />ADDRESS —7 C• I r C.i� A t2_—V -' 1I2_ vv4 Y _E�'`l caC-14-arc) ` 1�f'4 9 °JZctr. <br />Repair/Construction <br />Compliance Insurance <br />Escrow <br />Escrow <br />LOCATION SKETCH I Show Nort <br />_ <br />--- — -- — — ---- -- _T. --_ <br />7� <br />SHOW STREETS, BLDGS, TANKS, ISLANDS, PIPING (IF KNOWN), PUMPS OR DISPENSERS <br />Make & Type of Pump or Dispenser <br />Cover Over Lines <br />Approx Burial Depth <br />I-, <br />Weather <br />7�, <br />Pressure Suction <br />LEAK DETECTOR <br />KEY TYPES <br />FTA LEAK DETECTOR TEST INFORMATION Calibrate <br />Opening I-Element 10 PSI <br />LD Serial Time In Test Leak Holding Pass / <br />No/Product Key Number Resiliency Seconds Rate MUMin PSI Metering PSI Fail <br />A <br />LD 2000 <br />B <br />LD 2000 E <br />C <br />FXI V <br />D <br />FXI DV <br />E <br />STPMLD <br />F <br />STPMLD - D <br />G <br />STPMLD - E <br />H <br />STPMLD - D/E <br />Notes: <br />CONTRACTOR <br />CERTIFICATION <br />Technician: Zane A. Nimmo <br />--1_ <br />LINE TEST RESULTS <br />Tests were made on the line systems as noted in accordance with test procedures <br />prescribed for as detailed on the test chart on Side 2 of this form with results as follows: <br />LINE IDENTIFICATION NET VOLUME CHANGE PER HOUR <br />PETROTITE CERT# <br />CCA0202112304R <br />OTTL Lic#04-1676 <br />`... <br />0 C"_T <br />PASS /.FAIL / INCONCLUSIVE <br />PASS / FAIL / INCONCLUSIVE <br />PASS.-/ FAIL / INCONCLUSIVE <br />PASS / FAIL / INCONCLUSIVE <br />DCS <br />Trainee: <br />„...r r <br />—"� • p v % !U <br />QUIPMENT: PETRO TITE LINE TESTER <br />
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