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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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PR0231497
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
1/25/2022 10:43:11 AM
Creation date
11/10/2021 8:23:42 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0231497
PE
2361
FACILITY_ID
FA0000279
FACILITY_NAME
ESCALON MINI MART
STREET_NUMBER
1097
STREET_NAME
YOSEMITE
STREET_TYPE
AVE
City
ESCALON
Zip
95320
APN
22510001
CURRENT_STATUS
01
SITE_LOCATION
1097 YOSEMITE AVE
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\kblackwell
Tags
EHD - Public
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6. Decontamination Procedures : <br /> a. Will piping be decontaminated prior to removal? YES [ j NO [ ] <br /> b. Identify contractor performing decontamination : <br /> Name Phone O <br /> Address City Zip <br /> c, Describe method to be used for decontamination: <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> a. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: <br /> #Re <br /> Hauler Name Phone (� Hauler 9 i <br /> Address City Zip <br /> Permitted Disposal Site <br /> 6, a. Describe the method that will be utilized to purge and/or inert the piping: <br /> b. Piping Hauler: <br /> Name Phone (� <br /> Address City Zip <br /> Hauler Registration # (if hauled as hazardous) <br /> c. Piping Disposal Site: <br /> Name Phone (� <br /> Address City Zip <br /> EPA ID# (if transported to a permitted TSD facility) <br /> 7. Is the sampling firm an independent third party from the contractor? YES [ ) NO [ ) <br /> a. Identify sampling firm : <br /> Name Phone(.,,—) <br /> Address City Zip <br /> b. Identify laboratory performing analysis: <br /> Name Phone �) <br /> Address City Zip <br /> 8. Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: <br /> 9. a. Handling of excavated soil (Contaminated Soil Hazardous Waste Hauler): <br /> Name Hauler Registration # Phone L <br /> Address City Zip <br /> b. If soil is not to be hauled, describe what will be done with it: <br /> EH230038 (revised 12-11 -15) 4 <br />
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