My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
COMPLIANCE INFO_2006-2018
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
T
>
TRACY
>
1420
>
2300 - Underground Storage Tank Program
>
PR0231736
>
COMPLIANCE INFO_2006-2018
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
11/29/2023 12:42:29 PM
Creation date
6/23/2020 6:51:04 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2006-2018
RECORD_ID
PR0231736
PE
2361
FACILITY_ID
FA0002562
FACILITY_NAME
Sutter Valley Hospitals dba Sutter Tracy Community Hospital
STREET_NUMBER
1420
Direction
N
STREET_NAME
TRACY
STREET_TYPE
Blvd
City
Tracy
Zip
95376
APN
233-081-01
CURRENT_STATUS
01
SITE_LOCATION
1420 N Tracy Blvd
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231736_1420 N TRACY_2006-2018.tif
Tags
EHD - Public
Jump to thumbnail
< previous set
next set >
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
485
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
UNDERGROUND STORAGE TANK <br /> OVERFILL PREVENTION EQUIPMENT INSPECTION REPORT FORM (Page 1 of 1) <br /> Type of Action ❑Installation Inspection ❑Repair Inspection 9 36 Month Inspection <br /> I. FACILITY INFORMATION <br /> CERS ID Date of Overfill Prevention Equipment Inspection <br /> 10397599 10/3/2018 <br /> Business Name(Same as Facility Name or DBA-Doing Business As) <br /> Sutter Tracy Hospital <br /> Business Site Address City ZIP Code <br /> 1420 N. Tracy Blvd. Tracy 95376 <br /> II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION <br /> Name of UST Service Technician Performing the Inspection(Print as shown on the ICC Certification.) Phone# <br /> David Winkler (209) 744-0112 <br /> Contractor/Tank Tester License# ICC Certification# ICC Certification Expiration Date <br /> 08-1739 Ex.3/31/2020 8883059-UT 1/29/2020 <br /> Overfill Prevention Equipment Inspection Training and Certifications(List applicable certifications.) <br /> FF- EBW , Phil-Tite &EVR Phase 1 1009853708 Ex 11-16-18 OPW 104-633 Ex 3-14-2020 <br /> Emco Ex. 10-1-20 VR: B34975 ATG: 2/8/20 <br /> III. OVERFILL PREVENTION EQUIPMENT INSPECTION 1 <br /> Inspection Method ®Manufacturer Guidelines(Specify): <br /> Used: Removed Drop Tube §, I <br /> NMI i <br /> ❑Industry Code or Engineering Standard(Specify): <br /> ❑Engineered Method(Specify): ENVIRONMENT/\L, HEALTH <br /> Attach the inspection procedures and all documentation required to determine the results. #bi xtsachen.. WA <br /> TANK ID:(By tank number,stored product,etc.) DSL <br /> What is the tank inside diameter?(Inches) 96 <br /> Is the fill piping secondarily contained? ❑Yes ®No ❑Yes ❑No ❑Yes ❑ No ❑Yes ❑ No <br /> Is the vent piping secondarily contained? ❑Yes ®No ❑Yes ❑No ❑Yes ❑ No ❑Yes ❑ No <br /> Overfill Prevention Equipment Manufacturer(s) Emco <br /> A1100 <br /> What is the overfill prevention equipment response I ❑Shuts Off Flow ❑Shuts Off Flow ❑Shuts Off Flow ❑Shuts Off Flow <br /> when activated? ❑x Restricts Flow ❑Restricts Flow ❑Restricts Flow ❑Restricts Flow <br /> (Check all that apply.) <br /> ❑A/V Alarm ❑AN Alarm ❑AN Alarm ❑AN Alarm <br /> Are flow restrictors installed on vent piping? ❑Yes [E No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No <br /> At what level in the tank is the overfill prevention set <br /> to activate?(Inches from bottom of tank.) 80 <br /> What is the percent capacity of the tank at which the <br /> overfill prevention equipment activates? 89% <br /> Is the overfill prevention in proper operating condition ❑x Yes ❑Yes ❑Yes ❑Yes <br /> to respond when the substance reaches the <br /> appropriate level? ❑No(Specify in V.) ❑No(Specify in V.) ❑No(Specify in V.) ❑No(Specify in V.) <br /> IV. SUMMARY OF INSPECTION RESULTS <br /> Overfill Prevention Inspection Results ❑x Pass ❑Fail I ❑Pass ❑Fail 11 ❑Pass ❑Fail ❑Pass ❑Fail <br /> V. COMMENTS <br /> Any items marked"Fail'must be explained in this section. Any additional comments may also be provided here. <br /> VI. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS INSPECTION <br /> I hereby certify that the overfill prevention equipment was inspected in accordance with California Code of Regulations,Title 23, <br /> Division 3,Chapter 16,Section 2637.2 and all the information contained herein is accurate. <br /> UST Service Technician Signature <br /> If the facility has more components than this form accommodates,additional copies of this page may be attached. <br /> CERS=Catifomia Environmental Reporting System,ID=Identification,UST=Underground Storage Tank,ICC=International Code Council,AIV=Audible and Visual <br />
The URL can be used to link to this page
Your browser does not support the video tag.