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COMPLIANCE INFO_2020
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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EL DORADO
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6009
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2300 - Underground Storage Tank Program
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PR0542116
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COMPLIANCE INFO_2020
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Entry Properties
Last modified
12/24/2020 2:31:24 PM
Creation date
7/20/2020 9:31:38 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2020
RECORD_ID
PR0542116
PE
2351
FACILITY_ID
FA0024188
FACILITY_NAME
GRIN INVESTMENTS INC DBA: ARCO AM/PM
STREET_NUMBER
6009
Direction
N
STREET_NAME
EL DORADO
STREET_TYPE
ST
City
STOCKTON
Zip
95207
APN
08126064
CURRENT_STATUS
01
SITE_LOCATION
6009 N EL DORADO ST
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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UNDERGROUND STORAGE TANK <br /> SPILL CONTAINER TESTING REPORT FORM ( Page 1 of 1 ) <br /> Type of Action ❑ Installation Test ❑ Repair Test ❑X 12 Month Test <br /> I . FACILITY INFORMATION <br /> CERS ID Date of Spill Container Test <br /> 10776040 11 / 12/2019 <br /> Business Name (Same as Facility Name or DBA-Doing Business As) <br /> ARCO STOCKTON <br /> Business Site Address City ZIP Code <br /> 6009N NORTH ELDORADO STOCKTON 95207 <br /> II . UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION <br /> Name of UST Service Technician Performing the Test (Print as shown on the ICC Certification.) Phone # <br /> FELIX RAMIREZ (209 ) 744 - 0112 <br /> Contractor / Tank Tester License # ICC Certification # ICC Certification Expiration Date <br /> 08 - 1740 5 -31 -20 8883072 - UT 11 /9/2020 <br /> Spill Container Testing Training and Certifications (List applicable certifications.) <br /> Franklin Fueling - EBW & Phil Tite # 1009883708 11 /29/20 <br /> OPW # 104634 3- 14-20 <br /> III . SPILL CONTAINER TESTING INFORMATION <br /> Test Method Used : ❑X Manufacturer Guidelines (Specify) : OPW PHASE 1 LAKE TEST <br /> Z Industry Code or Engineering Standard (Specify) : <br /> ❑ Engineered Method (Specify) : <br /> # of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. <br /> TANK ID : (By tank number, stored product, etc.) 87 91 DIESEL <br /> Spill Container Manufacturer: OPW OPW OPW <br /> Method of Cathodic Protection : ZX Non-Metallic ❑X Non-Metallic ❑X Non-Metallic ❑ Non-Metallic <br /> ❑ Isolation ❑ Isolation ❑ Isolation ❑ Isolation <br /> Z Other (Specifyin V.) Z Other (Specifyin V) ❑ Other (Specifyin V.) ❑ Other (Specifyin V.) <br /> Inside Diameter of Spill Container: (Inches) 11 11 11 <br /> Depth of Spill Container: (Inches) 14 14 14 <br /> Does the spill container have a 5 gallon capacity? R Yes ❑ No ❑x Yes ❑ No El Yes ❑ No ❑ Yes ❑ No <br /> Method to Keep Spill Container Empty: ❑X Drain Valve ZX Drain Valve ❑X Drain Valve ❑ Drain Valve <br /> Z Onsite Pump ❑ Onsite Pump ❑ Onsite Pump ❑ Onsite Pump <br /> Z Other (Specifyin V.) ❑ Other (Specifyin V.) ❑ Other (Specifyin V) ❑ Other (Specifyin V.) <br /> IV. SUMMARY OF TESTING RESULTS <br /> Spill Container Test Results : Z Pass ❑ Fail ❑X Pass ❑ Fail ❑X Pass Z Fail ❑ Pass Z Fail <br /> V. COMMENTS <br /> Any items marked "Fail' above must be explained in this section . Any additional comments may also be provided here. <br /> VI . CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING <br /> I hereby certify that the spill containers were tested in accordance with California Code of Regulations , Title 23 , Division 3, <br /> Chapter 16, Section 2637 . 1 and all the information contained herein is accurate. <br /> UST Service Technician Signature i� _- <br /> j <br /> If the facility has more components than this form accommodates, additional copies of this page may be attached. <br /> CERS = California Environmental Reporting System, ID = Identification, UST = Underground Storage Tank, ICC = International Code Coundl <br />
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