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COMPLIANCE INFO_2021
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0231094
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COMPLIANCE INFO_2021
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Last modified
12/1/2021 4:32:32 PM
Creation date
3/8/2021 8:14:38 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0231094
PE
2361
FACILITY_ID
FA0003632
FACILITY_NAME
AJS MINI MART INC
STREET_NUMBER
7906
Direction
N
STREET_NAME
EL DORADO
STREET_TYPE
ST
City
STOCKTON
Zip
95210
APN
07935016
CURRENT_STATUS
01
SITE_LOCATION
7906 N EL DORADO ST
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 <br /> 6. SENSOR TESTING RESULTS <br /> List only sensors tested on date of this certification. List "Sensor ID"as labeled in system <br /> programming. Additional copies of this page may be attached to accommodate all sensors tested. <br /> Sensor lD Sensor Model Component(s) Monitored Pass Fail <br /> L-1 VR 794380-323 DISPENSER 1 &2 ✓❑ ❑ <br /> L-2 VR 794380-323 DISPENSER 3 &4 ✓❑ ❑ <br /> L-3 VR 794380-323 DISPENSER 5&6 ❑✓ ❑ <br /> L-4 VR 794380-323 DISPENSER 7 &8 ✓❑ ❑ <br /> L-5 VR 794380-208 87 1 STP ✓❑ ❑ <br /> L-6 VR 794380-323 87 1 FILL SUMP ❑✓ ❑ <br /> L-7 VR 794390-409 87 1 ANNULAR ✓❑ ❑ <br /> L-8 VR 794380-208 87 2 SLAVE ❑✓ ❑ <br /> L-9 VR 794380-323 87 2 FILL ❑✓ ❑ <br /> L-10 VR 794390-409 87 2 ANNULAR ✓❑ ❑ <br /> L-11 VR 794380-323 87 3 STP ❑✓ ❑ <br /> L-12 VR 794380-323 87 3 FILL SUMP ❑✓ ❑ <br /> L-13 VR 794390-409 87 3 ANNULAR ✓❑ ❑ <br /> L-14 VR 794380-323 91 STP ❑✓ ❑ <br /> L-15 VR 794380-323 91 FILL SUMP ❑✓ ❑ <br /> L-16 VR 794390-409 91 ANNULAR ❑✓ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> Describe all answers marked "No"or "Fail"and proposed remedy in Section 9. <br /> List all monitoring equipment either replaced or repaired in Section 9 <br /> Page 3of6 <br />
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