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COMPLIANCE INFO_2020
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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JACK TONE
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2300 - Underground Storage Tank Program
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PR0505264
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COMPLIANCE INFO_2020
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Entry Properties
Last modified
3/4/2021 8:17:39 AM
Creation date
1/17/2020 11:56:26 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2020
RECORD_ID
PR0505264
PE
2361
FACILITY_ID
FA0006672
FACILITY_NAME
FLYING J TRAVEL PLAZA #618*
STREET_NUMBER
1501
Direction
N
STREET_NAME
JACK TONE
STREET_TYPE
RD
City
RIPON
Zip
95366
APN
22811017
CURRENT_STATUS
01
SITE_LOCATION
1501 N JACK TONE RD
P_LOCATION
05
P_DISTRICT
004
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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i <br /> RECEIVED I <br /> SEP r. 9 2020 <br /> UST SYSTEM RETROFIT OR REPAIR <br /> `NVIR��IME�VTr?L HEALTH(Submit minlmum of 3 sets of plans&applications as originals will be retained by E <br /> _PAF?Tn,J�FNT <br /> 1. Site map enclosed? YES[3 NO[ <br /> 2. Submit copies of ICC Service Technician and/or Installer's certificate and all manufacturer training certificates for each <br /> person installing or testing any component that is repalred or replaced. Ensure a copy of the "Site Health and Safety <br /> Plan"is available on the jobsite as required by Title 8. <br /> 3. Detailed description of work to be completed. List components to be repaired or replaced and attach a diagram drawn <br /> to scale showing location of repairs and/or replacements. If repairing a component, describe how this will be done. (If <br /> adding piping, UDC's, or other UST equipment, or performing tank top upgrade, use the UST Installation Application <br /> pages 4-8 as necessary for a timely plan review): <br /> I <br /> Dispenser 13 & 24 Satellite Bravo SB989 Repairs : <br /> Install Retro-Fit repair kits at all sump entries inside UDC 13 & 24 satellite <br /> UDC 13 : (4) 3/4 Electrical 4 Bolt - RF-07-01-U, (1) 3" Product - RF-30-01-U <br /> UDC 24 (Sat) : (3) 3" Product - RF-30-01-U, (1) 3" Vapor - RF-30-01-U <br /> *Dispensers to be removed to access penetrations with-in UDC' s & <br /> reinstall dispenser after completion. * <br /> 4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br /> Bravo Retro Fit Sump Entry Repair Kits: <br /> UDC 13 : (4) 3/4 Electrical 4 Bolt - RF-07-01-U, (1) 3" Product - RF-30-01-U <br /> UDC 24 (Sat) : (3) 3" Product - RF-30-01-U, (1) 3" Vapor - RF-30-01-U <br /> i <br /> s <br /> i <br /> 1 <br /> i <br /> 1 <br /> I <br />
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