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COMPLIANCE INFO_2021
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0232523
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
12/28/2021 3:10:00 PM
Creation date
6/17/2021 10:43:04 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0232523
PE
2361
FACILITY_ID
FA0003833
FACILITY_NAME
Super Store Industries - Grocery Division
STREET_NUMBER
16888
STREET_NAME
MCKINLEY
STREET_TYPE
Ave
City
Lathrop
Zip
95330
CURRENT_STATUS
01
SITE_LOCATION
16888 McKinley Ave
P_LOCATION
07
P_DISTRICT
003
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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SAN .AN J O A O U I N Environmental Health Department <br /> — — C OU N Ty Amended 6/08/2021 Address Correction <br /> UST SYSTEM RV `ISG' OF u OR PAIR <br /> ( Submit minimum of 3 sets of plans & applications as originals will be retained by EHD ) <br /> 1 . Site map enclosed ? YES [ ] NO [ ] <br /> 2 . Submit copies of ICC Service Technician and/or Installer' s certificate and all manufacturer training <br /> certificates for each person installing or testing any component that is repaired or replaced . Ensure a copy of <br /> the " Site Health and Safety Plan " is available on the jobsite as required by Title 8 . <br /> 3 . Detailed description of work to be completed . List components to be repaired or replaced and attach a <br /> diagram drawn to scale showing location of repairs and/or replacements . If repairing a component , describe <br /> how this will be done . ( If adding piping , UDC ' s , or other UST equipment, or performing tank top upgrade , <br /> use the UST Installation Application pages 4-8 as necessary for a timely plan review) : <br /> Remove diesel Overspill Container and replace with new diesel Overspill Container . <br /> 4 . List of equipment to be used (Attach manufacturer' s specification sheets showing third -party approval ) : <br /> OPW Spill Container - OPW 1 C-2100C - DEVR <br /> i <br /> i <br /> 5 . Decontamination Procedures : <br /> a . Will piping be decontaminated prior to removal ? YES [ j NO [ ] <br /> b . Identify contractor performing decontamination : <br /> Name Phone ( ) <br /> Address City Zip <br /> I <br /> 3of6 <br />
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