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INSTALL 2016 TANK TOP UPGRADE
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0231435
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INSTALL 2016 TANK TOP UPGRADE
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Last modified
8/2/2019 3:32:32 PM
Creation date
8/2/2019 2:31:12 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
INSTALL
FileName_PostFix
2016 TANK TOP UPGRADE
RECORD_ID
PR0231435
PE
2361
FACILITY_ID
FA0000916
FACILITY_NAME
7-ELEVEN INC #19976
STREET_NUMBER
1399
Direction
N
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
APN
21633034
CURRENT_STATUS
01
SITE_LOCATION
1399 N MAIN ST
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
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KBlackwell
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EHD - Public
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Decontamination Procedures: RECEIVED <br />a. Will piping be decontaminated prior to removal? YES [ j NO.rf <br />b. Identify contractor performing decontamination: NOV 17 2016 <br />Name Phone L__) <br />Address City Zi IRONMENTAL HEALTH <br />� <br />G. Describe method to be used for decontamination: --UEPARTMENT_ <br />NJIk <br />d. DescrT how rinsate material will be stored onsite prior to manifestinn nffsitW_ <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br />Hauler Name __ N I A-- Phone U Hauler Reg# <br />Address <br />Permitted Disposal Site <br />City I Zip <br />6, a. Describe <br />,,the method that will be utilized <br />+to purge and/or inert the piping: <br />sc <br />b. Piping Hauler: <br />Name J����%i i` Phone <br />Address_ 1 `�b�..3�� C�..�re �c- City 11� teS} Zip qZ'4V0 <br />Hauler Registration # (if hauled as hazardous) L��0001 3 <br />c. Piping Disposal Site: <br />Name CA\0A�Csc1 t).� Phone ( ) <br />Address 3SS 1 Ski— City Zip <br />EPA 1D# (if transported to a permitted TSD facility) Cfl\j:) LA (a 3g <br />Is the sampling firm an independent third party from the contractor? YES [ ] NO ( ] <br />a. Identify sampling firm: <br />Name _`S-�u----K? t Phone R( kt 04C, <br />Address3b\.-I City )Rk"b �d�J ip 9 5�6 7b <br />b. Identify laboratory performing analysis: c� �. <br />Name._ tt�5� iS�y��t��CgqfR e Phon� SbyC) <br />Address._`��% �,IS�9l� xa City} A�"Lip �00� <br />8. Describe, in detail, how the soil and/or water sample(s) beneath1 the piping or dispenser will be obtained: <br />Ili 1, 'h- 1416L -a e2�— e_'. - 2 <br />9. a. Handling of excavated soil (Contaminated Soil Hazardous Waste ao Ig <br />l `� r �� o�� 2 0� <br />Name �1s l�r'C Hauler Registration # 1Phone (� <br />Address �f 7 % T �c (,t�/�„� , city ZqAJ+xh�l / - -Zip 1Z 6/1-5 <br />b. If soil is not to be hauled, describe what will be done with it: <br />4 <br />
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