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COMPLIANCE INFO_2020
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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KETTLEMAN
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2300 - Underground Storage Tank Program
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PR0231906
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COMPLIANCE INFO_2020
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Last modified
11/3/2021 4:04:16 PM
Creation date
1/17/2020 11:55:23 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2020
RECORD_ID
PR0231906
PE
2361
FACILITY_ID
FA0003776
FACILITY_NAME
KWIK SERV LODI BW 113*
STREET_NUMBER
420
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
06202042
CURRENT_STATUS
01
SITE_LOCATION
420 W KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT <br /> V. TANK SECONDARY CONTAINMENT INFORMATION (ANNULAR) <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer. <br /> A® B ® C❑ D❑ <br /> A❑ 77�- B C❑ D❑ <br /> Test Method Used: ❑ Manufacturer Guidelines: <br /> ® Industry Code or Engineering Standard: PEI/RP1200/Vacuum Test/10Hg for 1 hr. <br /> ❑ Engineered Method: <br /> Attach the testing procedures and all documents required to determine the results. #of Attached Pages: <br /> Tank Containment Testing Training and Certifications Expiration Date <br /> ICC Service Technician—Jeff Raven 9326216 8/31/2021 <br /> VI. COMMENTS <br /> Tested 87 and DSL annular after bucket replacement per county requirements. <br /> VI1. PRODUCT PIPING CONTAINMENT TESTING INFORMATION (SECONDARY LINE) <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer <br /> A❑ B❑ C❑ D❑ <br /> A❑ B ❑ C D❑ <br /> Test Method Used: ❑ Manufacturer Guidelines: <br /> ® Industry Code or Engineering Standard: PEI/RP1200/Pressure Test/5 psi for 1 HR <br /> ❑ Engineered Method: <br /> Attach the testing procedures and all documentation required to determine the results #of Attached Pages: <br /> Product Piping Containment Testing Training and Certifications Expiration Date <br /> ICC Service Technician- <br /> Interstitial Communication Verification Method Used: <br /> VIII. COMMENTS <br /> N/A <br />
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