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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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PR0231692
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COMPLIANCE INFO_2020
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Entry Properties
Last modified
12/22/2020 9:25:12 AM
Creation date
6/11/2020 3:51:43 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2020
RECORD_ID
PR0231692
PE
2361
FACILITY_ID
FA0000212
FACILITY_NAME
Mossdale Chevron
STREET_NUMBER
444
Direction
W
STREET_NAME
MOSSDALE
STREET_TYPE
RD
City
LATHROP
Zip
95330
CURRENT_STATUS
01
SITE_LOCATION
444 W MOSSDALE RD
P_LOCATION
99
P_DISTRICT
005
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❑ 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-5244364 1/4/2021 <br /> VI. COMMENTS <br /> With one inspector and two inspector trainees,conducted an annular vacuum test.All tests passed. <br /> VII. PRODUCT PIPING CONTAINMENT TESTING INFORMATION (SECONDARY LINE) <br /> Manufacturer Identify Tank ID from Section III for each Manufacturer <br /> A❑ B ❑ C DQ <br /> A B ❑ CQ DQ <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 r r <br /> N/A RECEIVED <br /> sP 0 4 a�7 <br /> I I LA UH <br /> IZ f`1 F.N'I' <br />
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