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COMPLIANCE INFO_2000-2005
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0231111
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COMPLIANCE INFO_2000-2005
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Last modified
1/26/2021 8:24:50 AM
Creation date
6/23/2020 6:42:59 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2000-2005
RECORD_ID
PR0231111
PE
2361
FACILITY_ID
FA0001659
FACILITY_NAME
QUIK STOP MARKET #7039
STREET_NUMBER
2285
Direction
E
STREET_NAME
FREMONT
STREET_TYPE
ST
City
STOCKTON
Zip
95205
APN
141-214-03
CURRENT_STATUS
01
SITE_LOCATION
2285 E FREMONT ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231111_2285 E FREMONT_2000-2005.tif
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EHD - Public
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NIFIED PROGRAM CONSOLIDATED FW1 <br /> TANKS <br /> UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br /> Pa e_of_ <br /> VI.PIPING CONSTRUCTION cheer au that a l <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SYSTEM TYPE 1.PRESSURE ❑2.SUCTION ❑3.GRAVITY 458. [11.PRESSURE ❑2.SUCTION ❑3.GRAVITY 459. <br /> CONSTRUCTION/ ❑1.SINGLE WALL [:13.LINED TRENCH [:199.OTHER 460. ❑1.SINGLE WALL ❑95.UNKNOWN 462. <br /> MANUFACTURER <br /> 162.DOUBLE WALL [195.UNKNOWN ❑2.DOUBLE WALL ❑99.OTHER <br /> MANUFACTURER A „ Q - S rK I-r O 461. MANUFACTURER 463. <br /> ❑ 1.BARE STEEL jd6.FRP COMPATIBLE W/100%METHANOL ❑1.BARE STEEL o <br /> ❑6.FRP CtZED <br /> PATIBLE W/100%METHANOL <br /> ❑2.STAINLESS STEEL ❑7.GALVANIZED STEEL [12.STAINLESS STEEL [17.GALV STEEL <br /> ❑3.PLASTIC COMPATIBLE WITH CONTENTS ❑95.UNKNOWN [13.PLASTIC COMPATIBLE W/CONTENTS [:18.FLEX16LE(HDPE) ❑99.OTHER <br /> [:14.FIBERGLASS ❑8.FLEXIBLE(HDPE) [199.OTHER [14.FIBERGLASS ❑9.CATHODIC PROTECTION <br /> ❑5.STEEL W/COATING ❑9.CATHODIC PROTECTION 464. ❑5.STEEL W/COATING ❑95.UNKNOWN 465. <br /> VII.PIPING LEAK DETECTION(Check all that apply) A descri tion ofthe monitoring program shall be submitted to the local agency.) <br /> UNDERGROUND PIPING ABOVEGROUND PIPING <br /> SINGLE WALL PIPING 466. SINGLE WALL PIPING 467. <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): <br /> ❑ I. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP ❑1. ELECTRONIC LINE LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP <br /> SHUT-OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION SHUT OFF FOR LEAK,SYSTEM FAILURE,AND SYSTEM DISCONNECTION <br /> +AUDIBLE AND VISUAL ALARMS. +AUDIBLE AND VISUAL ALARMS. <br /> ❑2. MONTHLY 0.2 GPH TEST ❑2. MONTHLY 0.2 GPH TEST <br /> ❑3. ANNUAL INTEGRITY TEST(0.1 GPH) [13. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> [14. DAILY VISUAL CHECK <br /> CONVENTIONAL SUCTION SYSTEMS CONVENTIONAL SUCTION SYSTEMS(Check all that apply) <br /> ❑5. DAILY VISUAL MONITORING OF PUMPING SYSTEM+TRIENNIAL PIPING <br /> INTEGRITY TEST(0.1 GPH) ❑5. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br /> SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): ❑6. TRIENNIAL INTEGRITY TEST(0.1 GPH) <br /> ❑7. SELF MONITORING SAFE SUCTION SYSTEMS(NO VALVES IN BELOW GROUND PIPING): <br /> GRAVITY FLOW ❑7. SELF MONITORING <br /> ❑9. BIENNIAL INTEGRITY TEST(0.1 GPH) GRAVITY FLOW(Check all that apply): <br /> ❑8. DAILY VISUAL MONITORING <br /> C19. BIENNIAL INTEGRITY TEST(0.1 GPH) <br /> SECONDARILY CONTAINED PIPING SECONDARILY CONTAINED PIPING <br /> PRESSURIZED PIPING(Check all that apply): PRESSURIZED PIPING(Check all that apply): <br /> 10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL l0. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br /> ALARMS AND(Check one) ALARMS AND(Check one) <br /> ❑a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS ❑a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br /> �b. AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM ❑b.AUTO PUMP SHUT OFF FOR LEAKS,SYSTEM FAILURE AND SYSTEM <br /> DISCONNECTION DISCONNECTION <br /> ❑c. NO AUTO PUMP SHUTOFF ❑c. NO AUTO PUMP SHUTOFF <br /> 11. AUTOMATIC LINE LEAK DETECTOR(3.0 GPH TEST)WITH FLOW SHUT <br /> OFF OR RESTRICTION [II1. AUTOMATIC LEAK DETECTOR <br /> ❑ <br /> 12. ANNUAL INTEGRITY TEST(0.1 GPH) ❑12. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> SUCTION/GRAVITY SYSTEM SUCTION/GRAVITY SYSTEM <br /> ❑ 13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS ❑13. CONTINUOUS SUMP SENSOR+AUDIBLE AND VISUAL ALARMS <br /> EMERGENCY GENERATORS ONLY(Check all that apply) EMERGENCY GENERATORS ONLY(Check all that apply) <br /> ❑ 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF ❑14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF <br /> AUDIBLE AND VISUAL ALARMS AUDIBLE AND VISUAL ALARMS <br /> ❑ 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) WITHOUT FLOW ❑I5. AUTOMATIC LINE LEAK DETECTOR 3 0 GPH TEST <br /> SHUT OFF OR RESTRICTION ( ) <br /> ❑ 16. ANNUAL INTEGRITY TEST(0.1 GPH) ❑16. ANNUAL INTEGRITY TEST(0.1 GPH) <br /> ❑ 17. DAILY VISUAL CHECK ❑17. DAILY VISUAL CHECK <br /> VIII.DISPENSER CONTAINMENT <br /> DISPENSER CONTAINMENT 468. ❑1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE ❑4. DAILY VISUAL CHECK 469. <br /> DATE INSTALLED 92. CONTINUOUS DISPENSER PAN SENSOR+AUDIBLE AND VISUAL ALARMS ❑5. TRENCH/LINER MONITORING <br /> Z 00 ❑3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR C]6. NONE <br /> DISPENSER+AUDIBLE AND VISUAL ALARMS <br /> IX.OWNER/OPERATOR SIGNATURE <br /> I certify that the information provided herein is true and accurate to the best of my knowledge. <br /> SIGNATURE OF G*r1NER/OP4RA-OR C 0 ktT R G T'04- DATE: 470. <br /> Z .� - 0 3 <br /> NAME OF OWNER/OPERATOR(print): TITLE OF OWNER/OPERATOR: 472, <br /> 1cNn-Ec Afo�( �n.Ef, gcTo�l a uIr. <br /> rPer-m-itNumber(Agency use only) 473. 1 Permit Approved By(Agency use only) 474. 1 Permit Expiration Date(Agency use only) 475. <br /> UPCF hwfwrc-b(1/99)-3/4 0 <br /> http://www.unidocs.org0 Rev.02/16/00 <br />
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