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COMPLIANCE INFO_2019
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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DR MARTIN LUTHER KING JR
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2300 - Underground Storage Tank Program
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PR0231057
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COMPLIANCE INFO_2019
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Last modified
6/28/2021 3:07:59 PM
Creation date
7/28/2020 8:15:35 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2019
RECORD_ID
PR0231057
PE
2361
FACILITY_ID
FA0003720
FACILITY_NAME
CHARTER WAY PETRO INC.
STREET_NUMBER
508
Direction
W
STREET_NAME
DR MARTIN LUTHER KING JR
STREET_TYPE
BLVD
City
STOCKTON
Zip
95206
APN
16504016
CURRENT_STATUS
01
SITE_LOCATION
508 W DR MARTIN LUTHER KING JR BLVD
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 2 of 6) <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 350 331 . 02 <br /> Check the appropriate boxes to indicate specific a ui mentins ected/serviced, <br /> MonitoringDevice Used Device Model # Monitorin Device Used Device Model # <br /> TANK ID : 87 TANK ID : 87B <br /> (By tank number, stored product, etcj (By tank number, stored product, etc. <br /> 0 In-Tank Gauging (SW Tank) MAG 1 0 In-Tank Gauging (SW Tank) MAG 1 <br /> I] Annular Space or Vault Sensor 420 Q Annular Space or Vault Sensor 420 <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> Product Piping Product Piping <br /> ❑ Mechanical LLD ❑ Mechanical LLD <br /> Q Electronic LLD PLLD ❑ Electronic LLD PLLD <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> Z Sump Sensor 208 p Sump Sensor 208 <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 /> Monitoring Device Used Device Model # Monitoring Device Used Device Model # <br /> TANK ID : 91 TANK ID : <br /> 8 tank number, storedproduct, etc. 8 tank number, storedproduct, etc. <br /> 0 In-Tank Gauging (SW Tank) MAG 1 ❑ In-Tank Gauging (SW Tank) <br /> 0 Annular Space or Vault Sensor 420 ❑ Annular Space or Vault Sensor <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> Product Piping Product Piping <br /> ❑ Mechanical LLD ❑ Mechanical LLD <br /> Electronic LLD PLLD ❑ Electronic LLD <br /> ❑ VPH Sensor (Piping) ❑ VPH Sensor (Piping) <br /> ❑x Sump Sensor 208 ❑ 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 /> ID = Identification, SW = Single-Walled, VPH = VacuumlPressureMydrostatic, LLD = Line Leak Detector <br />
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