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COMPLIANCE INFO_2020
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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PR0231906
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COMPLIANCE INFO_2020
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Entry Properties
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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1. TANK CONTAINMENT Annular <br /> Company Name: B.Z. Service Station Maintenance <br /> Company Address: 1041 Triangle Ct.,West Sacramento,CA 95605 <br /> Credentials: ®CSLB Licensed Contractor ❑ SWRCB Licensed Tank Tester <br /> License Type: ICC License Number: 433159 <br /> Test Equipment Used: VACUUM GAUGE Equipment Resolution:0.5" <br /> Tank#87 Tank#DSL Tank# Tank# <br /> Wait time between applying <br /> pressure/vacuum/water and 5min 5min <br /> starting test: <br /> Test Start Time: 10:15 10:15 <br /> Initial Reading(Rj): -10" -10" " <br /> Test End Time: 11:15 12:45 <br /> Final Reading(RF): <br /> -10" -10" " <br /> Test Duration: 1 HR I HR 1 HR I HR <br /> Change in Reading(RF-Rj): 0 0 <br /> Pass/Fail Threshold or Criteria: 0 0 0 0 <br /> Test Result: ®Pass ❑Fail ® Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> Was sensor removed for testing? ❑Yes❑No®NA ❑Yes❑No®NA ❑ Yes❑No❑Nn ❑ Yes❑No❑NA <br /> Was sensor properly replaced and ❑ Yes❑No®NA E]Yes❑No®NA ❑ Yes E]No E]NA El Yes❑No E] NA <br /> verified functional after testis<�? <br /> Test Equipment Used:VACUUM GAUGE Equipment Resolution:0.5" <br /> Tank# Tank# Tank# Tank# <br /> Wait time between applying <br /> pressure/vacuum/water and <br /> starting test: <br /> Test Start Time: <br /> Initial Reading(Ri): " <br /> Test End Time: <br /> Final Reading(RF): <br /> Test Duration: 1 HR 1 HR 1 HR 1 HR <br /> Change in Reading(RF-Rj): <br /> Pass/Fail Threshold or Criteria: 0 0 0 0 <br /> Test Result: ❑ Pass ❑Fail ❑ Pass ❑ Fail ❑Pass ❑Fail ❑ Pass ❑ Fail <br /> Was sensor removed for testing? ❑Yes❑No❑NA ❑Yes❑No❑NA ❑Yes❑No❑NA ❑Yes❑No❑NA <br /> Was sensor properly replaced and ❑Yes❑No❑NA ❑Yes❑No❑NA ❑Yes❑No❑NA ❑Yes❑No❑NA <br /> verified functional after testing? <br /> N I <br /> I= <br /> Comments—(include information on repairs made prior to testing, and recom enECE.,faiW tests <br /> MAR 16 2025 <br /> ENVIRONMENTAL HEAL] <br /> DEPARTMENT <br />
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