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COMPLIANCE INFO 2003 - 2008
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0231706
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COMPLIANCE INFO 2003 - 2008
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Last modified
6/11/2019 11:42:03 AM
Creation date
4/10/2019 2:41:16 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2003 - 2008
RECORD_ID
PR0231706
PE
2361
FACILITY_ID
FA0000485
FACILITY_NAME
FLAG CITY CHEVRON
STREET_NUMBER
6421
STREET_NAME
CAPITOL
STREET_TYPE
AVE
City
LODI
Zip
95242
APN
05532024
CURRENT_STATUS
01
SITE_LOCATION
6421 CAPITOL AVE
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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KBlackwell
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EHD - Public
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9. SPILL/OVERFILL CONTAIN1v1E Y 1 YAJO.a <br />Facility is Not Equipped With Spill/Overfl- ntainment Boxes ❑ <br />Spill/Overfill Containment Boxes are Presein, but were Not Tested ❑ Indus Standard ❑Professional Engineer <br />Test Method Developed By: ❑ Spill Bucket Manufacturer <br />Industry <br />❑ Other (Spec) <br />❑ Vacu.um Hydrostatic <br />Test Method Used: ❑ Pressure <br />❑ Other (S eco) <br />�r 2 Equipment Resolution <br />Test Equipment Used: ,:a�mr=a?,r:'�a,� /�am,.E��.r:�r,�, <br />2 �r� ..�. 5i.: ° kti� xit:1 l�i r��c F4iti?i�°EiitliAuL1 <br />"'Kr WRY, <br />SYKiaa#s 1 UC ,F1'�inafiiat4 r r WiamNk Ili BOX# lJ%�Splll BOX# <br />n `�i Spill Box # 1 ill Box SP 1 <br />r <br />Bucket Diameter: <br />Bucket Depth: 1 5 ' j 1- <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test: 3rD 13 <br />Test Start Time: -3 <br />' <br />Initial Reading (RI): 3 r G 5 `J <br />Test End Time: <br />Final Reading (RF): <br />Test Duration: <br />Change in Reading (RF-RI): <br />Pass/Fail Threshold or..... <br />r <br />Criteria: pass ❑Fail <br />Test Result <br />Pass L1 Fail ,' Pass ❑ Fail Pass ❑Fail <br />CommeIIl�S — (include in or oration on re aifs made prior to testing, and recommended follow-up,for failed tests) <br />Please direct any comments regarding this form to: <br />SVWRCB UST Program, Attn: Scott Bacon <br />1001 "I" Street, Box 944212 <br />Sacramento, CA 95814 <br />Phone: (916) 341-5873, Fax: (916) 341-5808 <br />e-mail: bacons@cwp.swreb.ca.gov <br />I <br />
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