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COMPLIANCE INFO_2021
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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REYNOLDS RANCH
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2300 - Underground Storage Tank Program
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PR0535432
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COMPLIANCE INFO_2021
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Last modified
1/3/2022 4:03:29 PM
Creation date
1/20/2021 9:53:12 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0535432
PE
2351
FACILITY_ID
FA0020431
FACILITY_NAME
COSTCO WHOLESALE #1091
STREET_NUMBER
2680
STREET_NAME
REYNOLDS RANCH
STREET_TYPE
PKWY
City
LODI
Zip
95240
CURRENT_STATUS
01
SITE_LOCATION
2680 REYNOLDS RANCH PKWY
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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MONITORING SYSTEM CERTIFICATION FORM (Page 3 of 6) <br /> Monitoring Device Used Device Model# Monitoring Device Used Device Model# <br /> Vent/Transition Sump ID: Additive Trans Sump Vent/Transition Sump ID: Unleaded Vent Sump <br /> ® Sump Sensor 794380-323 ® Sump Sensor 794380-323 <br /> ®VPH Sensor 794380-304 ®VPH Sensor 794380-304 <br /> UDC ID: 1 & 2 UDC ID: 3 & 4 <br /> ® Electronic Sensor 794380-323 ® Electronic Sensor 794380-323 <br /> ® Mechanical Device OPW Shear Valve ® Mechanical Device OPW Shear Valve <br /> ®VPH Sensor 794380-304 ®VPH Sensor 794380-304 <br /> UDC ID: 5 & 6 UDC ID: 7 & 8 <br /> ® Electronic Sensor 794380-323 ® Electronic Sensor 794380-323 <br /> ® Mechanical Device OPW Shear Valve ® Mechanical Device OPW Shear Valve <br /> ®VPH Sensor 794380-304 ®VPH Sensor 794380-304 <br /> UDC ID: 9 & 10 UDC ID: 11 & 12 <br /> ® Electronic Sensor 794380-323 ® Electronic Sensor 794380-323 <br /> ® Mechanical Device OPW Shear Valve ® Mechanical Device OPW Shear Valve <br /> ®VPH Sensor 794380-304 ®VPH Sensor 794380-304 <br /> UDC ID: 13 & 14 UDC ID: 15 & 16 <br /> ® Electronic Sensor 794380-323 ® Electronic Sensor 794380-323 <br /> ® Mechanical Device OPW Shear Valve ® Mechanical Device OPW Shear Valve <br /> ®VPH Sensor 794380-304 ®VPH Sensor 794380-304 <br /> UDC ID: UDC ID: <br /> ❑ Electronic Sensor ❑ Electronic Sensor <br /> ❑ Mechanical Device ❑ Mechanical Device <br /> ❑VPH Sensor ❑VPH Sensor <br /> UDC ID: UDC ID: <br /> ❑ Electronic Sensor ❑ Electronic Sensor <br /> ❑ Mechanical Device ❑ Mechanical Device <br /> ❑VPH Sensor ❑VPH Sensor <br /> Other Monitored Component ID: Other Monitored Component ID: <br /> ❑ Other(Specify in section Vll.) ❑ Other(Specify in section Vll.) <br /> Other Monitored Component ID: Other Monitored Component ID: <br /> ❑ Other(Specify in section Vll.) I] ❑ Other(Specify in section Vll.) <br /> Other Monitored Component ID: Other Monitored Component ID: <br /> ❑ Other(Specify in section Vll.) �A ❑ Other(Specify in section Vll.) <br /> Include information for every underground storage tank component monitored by this monitoring system control panel. If the monitoring <br /> system control panel monitors more components than this form accommodates,additional copies of these pages may be attached. <br /> VIII. COMMENTS <br /> Use this section to provide any additional comments about the inventory of the equipment certified. <br /> T4 Unleaded Additive has a shared Fill and STP sump. All sensors are covered in Piping sump listing. <br />
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