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COMPLIANCE INFO_2019
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2300 - Underground Storage Tank Program
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PR0516736
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COMPLIANCE INFO_2019
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Last modified
9/22/2021 11:36:54 AM
Creation date
9/28/2020 9:28:40 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2019
RECORD_ID
PR0516736
PE
2361
FACILITY_ID
FA0012764
FACILITY_NAME
SAFEWAY FUEL CENTER #1769
STREET_NUMBER
2802
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
CURRENT_STATUS
01
SITE_LOCATION
2802 COUNTRY CLUB BLVD
P_LOCATION
01
P_DISTRICT
003
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 3 of 6) <br /> Monitoring Device Used Device Model # Monitoring Device Used Device Model # <br /> VENT f TRANSITION SUMP ID : VENT I TRANSITION SUMP ID : <br /> ❑ Sump Sensor ❑ Sump Sensor <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> UDC ID : 1 -2 UDC ID : 34 <br /> ® Electronic Sensor VR 794380-208 ® Electronic Sensor VR 794380-208 <br /> ❑ Mechanical Device ❑ Mechanical Device <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> UDC ID : 5-6 UDC ID : 7-8 <br /> ® Electronic Sensor VR 794380-208 ® Electronic Sensor VR 794380-208 <br /> ❑ Mechanical Device ❑ Mechanical Device <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> UDC ID : 9- 10 UDC ID : 11 - 12 <br /> ® Electronic Sensor VR 794380-208 ® Electronic Sensor VR 794380-208 <br /> ❑ Mechanical Device ❑ Mechanical Device <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> UDC ID : 13- 14 UDC ID : 15- 16 <br /> ® Electronic Sensor VR 794380-208 ® Electronic Sensor VR 794380-20 $ <br /> ❑ Mechanical Device ❑ Mechanical Device <br /> ❑ VPH Sensor ❑ VPH Sensor <br /> Other Monitored Component ID : <br /> FOt7her Monitored Component ID : <br /> ❑ Other (Specify in section VIL) Other (Specify in section VII.) <br /> Other Monitored Component ID : Other Monitored Component ID : <br /> ❑ Other (Specify in section Vll.) ❑ Other (Specify in section VII.) <br /> Other Monitored Component ID : Other Monitored Component ID : <br /> ❑ Other (Specify in section VlL) ❑ Other (Specify in section V1L) <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 /> Estop - Tested & Passed . <br /> Shur Valves " Tested & Passed . <br /> Premium & Diesel Share Annular Sensor. <br /> i <br /> ID = idenlit'ication, VPH = Vacuum/PressureMydrostatic, UDC = UnderZispenser Containment <br />
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