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COMPLIANCE INFO_2021
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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PR0231216
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COMPLIANCE INFO_2021
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Last modified
8/17/2021 1:13:46 PM
Creation date
1/29/2021 11:53:53 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0231216
PE
2361
FACILITY_ID
FA0002480
FACILITY_NAME
SHOP N GO 3
STREET_NUMBER
4511
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
11023011
CURRENT_STATUS
01
SITE_LOCATION
4511 PACIFIC AVE
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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Underground Storage Tank <br />Secondary Containment Testing Report Form <br />8. SUMP/UDC TEST <br />Test Method Developed by ❑ Manufacturer ❑ Industry Standard ® Professional Engineer <br />Test Type ❑ Pressure ❑ Vacuum ® Hydrostatic <br />Test Equipment Used: Caldwell Level Change Indicator <br />Sump/UDC ID <br />1 -PS -87 <br />2 -PS -91 <br />Total Cont. <br />Total Cont. <br />Sump Manufacturer <br />Western FG <br />Western FG <br />27" <br />27" <br />Sump Depth (inches) <br />42 1/2" <br />41" <br />11" <br />11" <br />Sump Bottom to Top of <br />Highest Pipe Penetration <br />(inches) <br />17" <br />17" <br />12:22 <br />12:27 <br />Test Start Time <br />12:07 <br />12:12 <br />.001 <br />.001 <br />Initial Reading <br />.001 <br />.001 <br />12:52 <br />12:57 <br />Test End Time <br />12:37 <br />12:42 <br />.001 <br />.001 <br />Final Reading <br />.001 <br />.001 <br />0 <br />0 <br />Change in Reading <br />0 <br />0 <br />> .002 <br />> .002 <br />Pass /Fail Criteria <br />> .002 <br />> .002 <br />® Pass ❑ Fail <br />® Pass ❑ Fail <br />Tightness Test Results <br />M Pass ❑ Fail <br />® Pass ❑ Fail <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />Sump/UDC ID <br />UDC 1&2 <br />UDC 3&4 <br />UDC 5&6 <br />Sump Manufacturer <br />Total Cont. <br />Total Cont. <br />Total Cont. <br />Sump Depth (inches) <br />27" <br />27" <br />27" <br />Sump Bottom to Top of <br />Highest Pipe Penetration <br />(inches) <br />11" <br />11" <br />11" <br />Test Start Time <br />12:17 <br />12:22 <br />12:27 <br />Initial Reading <br />.001 <br />.001 <br />.001 <br />Test End Time <br />12:47 <br />12:52 <br />12:57 <br />Final Reading <br />.001 <br />.001 <br />.001 <br />Change in Reading <br />0 <br />0 <br />0 <br />Pass/Fail Criteria <br />> .002 <br />> .002 <br />> .002 <br />Tightness Test Results <br />® Pass ❑ Fail <br />® Pass ❑ Fail <br />® Pass ❑ Fail <br />❑ Pass ❑ Fail <br />Additional copies of this page may be attached. <br />All tests marked "Fail' and any repairs made before or during the tightness test must be described in <br />the COMMENTS section. <br />Page 3 of 5 <br />
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