My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
COMPLIANCE INFO_2020
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
E
>
ELEVENTH
>
950
>
2300 - Underground Storage Tank Program
>
PR0231401
>
COMPLIANCE INFO_2020
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
11/19/2024 10:19:34 AM
Creation date
8/27/2020 1:24:43 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2020
RECORD_ID
PR0231401
PE
2361
FACILITY_ID
FA0006388
FACILITY_NAME
CENTRAL GAS TRACY
STREET_NUMBER
950
Direction
W
STREET_NAME
ELEVENTH
STREET_TYPE
ST
City
TRACY
Zip
95376
APN
23406002
CURRENT_STATUS
01
SITE_LOCATION
950 W ELEVENTH ST
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\kblackwell
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
32
PDF
View images
View plain text
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 /> 10182092 8/10/2020 <br /> Business Name(Same as Facility Name or DBA-Doing Business As) <br /> KWIK SERV <br /> Business Site Address City ZIP Code <br /> 950 11TH STREET ITRACY, CA 195376 <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 /> DAVID WINKLER (209) 744-0112 <br /> Contractor I Tank Tester License# ICC Certification# ICC Certification Expiration Date <br /> 08-1739 Ex.3/31/20 8883059-UT 1/27/2022 <br /> Spill Container Testing Training and Certifications(List applicable certifications.) <br /> Franklin Fueling - EBW& Phil Tite #10009853708 Ex. 11/29/20 <br /> OPW#104-633 Ex. 3/13/2022 <br /> III. SPILL CONTAINER TESTING INFORMATION <br /> Test Method Used: ❑x Manufacturer Guidelines(Specify): WATER TEST <br /> ❑Industry Code or Engineering Standard(Specify): <br /> ❑Engineered Method(Specify): <br /> Attach the testing procedures and all documentation required to determine the results. #of Attached Pages <br /> TANK ID: (By tank number,storedproduct,etc.) 87 91 DSL <br /> Spill Container Manufacturer: OPW OPW OPW <br /> Method of Cathodic Protection: ❑x Non-Metallic ❑x Non-Metallic ❑x Non-Metallic ❑Non-Metallic <br /> ❑Isolation ❑Isolation ❑Isolation ❑Isolation <br /> ❑Other(Specify in v.) ❑Other(Specify in V.) ❑Other(Specify in V) ❑Other(Specify in V) <br /> Inside Diameter of Spill Container:(Inches) 12 12 12 <br /> Depth of Spill Container:(Inches) 15 15 15 <br /> Does the spill container have a 5 gallon capacity? El Yes ❑No [j]Yes ❑No 0 Yes ❑No ❑Yes ❑No <br /> Method to Keep Spill Container Empty: ❑x Drain Valve ❑x Drain Valve ❑x Drain Valve ❑Drain Valve <br /> ❑Onsite Pump ❑Onsite Pump ❑Onsite Pump ❑Onsite Pump <br /> ❑Other(Specify in V) ❑Other(Specify in V) ❑Other(Specify in V.) ❑Other(Specify in V.) <br /> IV. SUMMARY OF TESTING RESULTS <br /> Spill Container Test Results: 0 Pass ❑ Fail X Pass ❑Fail I ❑x Pass ❑ Fail ❑Pass ❑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 ^ 1 <br /> If the facility has more components than this form accommodates,additional copies of this page maybe attached. <br /> CERS=Calffomia Environmental Reporting System,ID=Identification,UST=Underground Storage Tank,ICC=International Code Council <br />
The URL can be used to link to this page
Your browser does not support the video tag.
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).