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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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PR0231333
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COMPLIANCE INFO_2020
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Last modified
10/8/2020 7:41:10 AM
Creation date
6/1/2020 1:55:45 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2020
RECORD_ID
PR0231333
PE
2361
FACILITY_ID
FA0003711
FACILITY_NAME
LAKEWOOD CHEVRON
STREET_NUMBER
236
Direction
N
STREET_NAME
HAM
STREET_TYPE
LN
City
LODI
Zip
95240
APN
03710028
CURRENT_STATUS
01
SITE_LOCATION
236 N HAM LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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SJGOV\gmartinez
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EHD - Public
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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 2 of s) <br /> VI . INVENTORY OF EQUIPMENT CERTIFIED <br /> A separate Monitoring System Certification Form must be prepared for each monitoring system control panel <br /> Make of Monitoring System Control Panel Model of Monitoring System Control Panel Software Version Installed <br /> VEEDER ROOT TLS 350 329 . 01 <br /> Check the appropriate boxes to indicate s ecific a ui ment in ected/serviced, <br /> Monitoring Device Used J Device Model # Monitoring Device Used Device Model # <br /> TANK ID : TANK ID : 91 <br /> B tank number, stored product, etc. $ 7 (BV tank number, stored product, etc. <br /> ❑ In-Tank Gauging (SW Tank) ❑ In-Tank Gauging (SW Tank) <br /> ❑x Annular Space or Vault Sensor 409 Z Annular Space or Vault Sensor 409 <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> Product Piping Product Piping <br /> Q Mechanical LLD FE PETRO 0 Mechanical LLD FE PETRO <br /> ❑ Electronic LLD ❑ Electronic LLD <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Fill Piping Fill Piping <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Vent Piping Vent Piping <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Vapor Recovery Piping Vapor Recovery Piping <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Monitorin Device Used Device Model # Monitorin Device Used Device Model # <br /> TANK ID : DSL TANK ID : <br /> (By tank number, stored product, (By tank number, stored product, etc. <br /> ❑ In-Tank Gauging (SW Tank) ❑ In-Tank Gauging (SW Tank) <br /> ❑ Annular Space or Vault Sensor 407 ❑ Annular Space or Vault Sensor <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> Product Piping Product Piping <br /> ❑x Mechanical LLD RED JACKET ❑ Mechanical LLD <br /> ❑ Electronic LLD ❑ Electronic LLD <br />� <br /> El VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br />€ ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Fill Piping Fill Piping <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) ❑ VPH Sensor (Sump) <br /> Vent Piping Vent Piping <br /> El Sensor (Piping) El VPH Sensor (Piping) <br /> E] Sump Sensor El Sump Sensor <br /> El Sensor (Sump) [:1 VPH Sensor (Sump) <br /> Vapor Recovery Piping Vapor Recovery Piping <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor (Sump) <br /> El <br /> Sensor (Sump) <br /> ID = Identification, SW = Single-Walled, VPH = VacuumlPressurehiydrostatic, LLD = Line Leak Detector <br />
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