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COMPLIANCE INFO_2021
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0231669
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COMPLIANCE INFO_2021
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Last modified
8/30/2022 11:20:13 AM
Creation date
4/1/2021 8:34:51 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0231669
PE
2361
FACILITY_ID
FA0001480
FACILITY_NAME
JACKSONS ENERGY #6822
STREET_NUMBER
2132
STREET_NAME
MARIPOSA
STREET_TYPE
RD
City
STOCKTON
Zip
95205
APN
17306035
CURRENT_STATUS
01
SITE_LOCATION
2132 MARIPOSA RD
P_LOCATION
01
P_DISTRICT
001
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 794380-208 DISPENSER 13 & 14 ✓❑ ❑ <br /> L-2 794380-208 DISPENSER 5& 6 ✓❑ ❑ <br /> L-3 794380-208 DISPENSER 7&8 ❑✓ ❑ <br /> L-4 794380-208 DISPENSER 11 & 12 ✓❑ ❑ <br /> L-5 794380-208 DISPENSER 3&4 ✓❑ ❑ <br /> L-6 794380-208 DISPENSER 9 & 10 ❑✓ ❑ <br /> L-7 794380-208 DISPENSER 1 & 2 ✓❑ ❑ <br /> L-9 794380-208 UNLEAD STP SUMP ❑✓ ❑ <br /> L-10 794380-208 PLUS STP SUMP ❑✓ ❑ <br /> L-11 794380-208 PREMIUM STP SUMP ✓❑ ❑ <br /> L-12 794380-208 DIESEL STP SUMP ❑✓ ❑ <br /> L-13 794380-208 UNLEAD FILL SUMP ❑✓ ❑ <br /> L-14 794380-208 PLUS FILL SUMP ✓❑ ❑ <br /> L-15 794380-208 PREMIUM FILL SUMP ❑✓ ❑ <br /> L-16 794380-208 DIESEL FILL SUMP ❑✓ ❑ <br /> L-17 Ronan LS3 UNLEAD ANNULAR ❑✓ ❑ <br /> L-18 794390-420 PLUS ANNULAR ❑✓ ❑ <br /> L-19 Ronan LS3 PREMIUM ANNULAR ✓❑ ❑ <br /> L-20 Ronan LS3 DIESEL ANNULAR ❑✓ ❑ <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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