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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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Work Order Job : 339542 <br /> PPt[ <br /> Contractor License: 485184 PO # : 3382477 <br /> Ref # 1 3382477 <br /> Category : Tanks-Lines Unit# : 03 <br /> Component: Turbine Relay Item : TANK <br /> Failure: Damaged-Worn Serial # : <br /> Repair Replaced Same Model Task# : 11 <br /> Enter Date/Time of Service (Military Time): 10 -25-2019 08 : 00 The following data was recorded by (Tech Mike Smith <br /> First/Last Name): <br /> Reviewed Site Maintenance Log AND Alert COMPLETE Issue reported is for grade: PREMIUM <br /> Service History for recent service : <br /> Confirmed Sensor(s) in lowest position : CONFIRMED Waste Disposal left on site: NO WASTE <br /> GENERATED <br /> Attached picture of waste drum label with an NOT REQUIRED While addressing this task I created and No alarms created <br /> accumulation date clearly written : cleared the following new Monitoring System <br /> alarm (s): <br /> Update Site Maintenance Log , TAKE COMPLETE Name of person site keys returned to OR Did Did not use <br /> PICTURE and attach picture to job: Not Use : <br /> The status of this task is : CLOSED - COMPLETE Brief Summary of Repairs or Additional Replaced worn <br /> Details: product relay on 91 <br /> grade <br /> Category: Tanks-Lines Unit# ; <br /> Component: Mech Leak Det. Item ; PERMIT <br /> Failure ; Permit Inquiry- Environmental Serial# : <br /> Repair: Not Required Task# : 12 <br /> Labor and Travel <br /> Start Date Tech Name Travel Labor Total Hours <br /> 10/24/2019 7 : 30 AM Mike Smith 0 . 50 3 .25 3 .75 <br /> 10/25/2019 7 : 23 AM Mike Smith 1 ,25 7.50 8 .75 <br /> 10/25/2019 7 : 30 AM Samantha McMahan 2.25 5 . 75 8200 <br /> Totals: 4.00 16.50 20.50 <br /> Parts and Materials <br /> Entry Date Description Qty <br /> 10/24/2019 1 Mt, 0-Ring, Turbine, AIG 1 .00 <br /> 10/24/2019 Check Valve, Preset 1 .00 <br /> 10/25/2019 Relay, Product Contactor 1 .00 <br /> 10/25/2019 Assy, Yoke, w/Electrical Plug 1 .00 <br /> 10/24/2019 Leak Detector, Mechanical 1.00 <br /> 10/25/2019 t Permit Agency Charge 1 .00 <br /> 10/25/2019 Permit Inquiry Fee 1 .00 <br /> Report Date : 11/ 1 / 2019 8 , 54 : 14 AM PST Page 4 of 5 <br />�I <br />
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