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COMPLIANCE INFO_2019
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0537919
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COMPLIANCE INFO_2019
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Last modified
11/30/2022 8:54:32 AM
Creation date
9/16/2020 11:08:49 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2019
RECORD_ID
PR0537919
PE
2351
FACILITY_ID
FA0021886
FACILITY_NAME
Love's Travel Stop #538
STREET_NUMBER
15250
Direction
N
STREET_NAME
THORNTON
STREET_TYPE
RD
City
Lodi
Zip
95242
CURRENT_STATUS
01
SITE_LOCATION
15250 N THORNTON RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\kblackwell
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EHD - Public
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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page s of s) <br /> Monitoring Device Used Device Model # MonItqK!ncLl Device Model # <br /> VENT I TRANSITION SUMP ID : VENT BOX VENT I TRANSITION SUMP ID : <br /> ❑x Sump Sensor 323 ❑ Sump Sensor <br /> ❑x VPH Sensor 304 ❑ VPH Sensor <br /> UDC ID : 1 -2 UDC ID : 3 =4 <br /> ❑x Electronic Sensor 323 Z Electronic Sensor 323 <br /> ❑ Mechanical Device ❑ Mechanical Device <br /> ❑x VPH Sensor 304 Z VPH Sensor 304 <br /> UDC ID : 5 -6 UDC ID : M <br /> ❑x Electronic Sensor 323 9 Electronic Sensor 323 <br /> ❑ Mechanical Device ❑ Mechanical Device <br /> ❑x VPH Sensor 304 x❑ VPH Sensor 304 <br /> UDC ID : 9 - 10 UDC ID : 11 = 12 <br /> ❑x Electronic Sensor 323 p Electronic Sensor 323 <br /> ❑ Mechanical Device ❑ Mechanical Device <br /> VPH Sensor 304 Z VPH Sensor 304 <br /> UDC ID : 13 - 14 UDC ID : 15 = 16 <br /> ❑x Electronic Sensor 323 0 Electronic Sensor 323 <br /> ❑ Mechanical Device ❑ Mechanical Device <br /> ❑x VPH Sensor 304 p VPH Sensor 304 <br /> Other Monitored Component ID : Other Monitored Component ID : <br /> ❑ Other (Specify in section Vll.) ❑ Other (Specify in section <br /> Other Monitored Component ID : Other Monitored Component ID : <br /> El (Specify in section Vll.) El Other (Specify in section Vll.) <br /> Other Monitored Component ID : Other Monitored Component ID : <br /> ❑ Other (Specify in section Vll.) ❑ Other (Specify in section VII) <br /> Include information for every underground storage tank component monitored by this monitoring system control panel. If the monitoring system <br /> control panel monitors more components than this form accommodates, additional copies of these pages may be attached. <br /> VII . COMMENTS <br /> Use this section to provide additional comments about the inventory of the equipment certified. <br /> ID = Identification, VPH = Vacuum/Pressure"drostatic, UDC = Under-Dispenser Containment <br />
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