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COMPLIANCE INFO_2022
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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EL DORADO
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2300 - Underground Storage Tank Program
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PR0231092
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COMPLIANCE INFO_2022
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Last modified
12/15/2022 10:56:37 AM
Creation date
2/2/2022 10:50:24 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2022
RECORD_ID
PR0231092
PE
2361
FACILITY_ID
FA0001946
FACILITY_NAME
El Dorado Food Mart
STREET_NUMBER
1901
Direction
S
STREET_NAME
EL DORADO
STREET_TYPE
ST
City
STOCKTON
Zip
95206
APN
16508019
CURRENT_STATUS
01
SITE_LOCATION
1901 S EL DORADO ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\gmartinez
Tags
EHD - Public
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Appendix VIII <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair ❑✓ 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID 10180839 <br /> 0180839 Test Date 09-30-2021 <br /> Facility Name MONTEREY FUEL <br /> Facility Address 1901 EL DORADO STREET City ZIP 95616 <br /> d <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> Afforda Test 209-744-0112 <br /> Mailing Address 416 2nd St Galt CA 95632 <br /> Service Technician Performing Test Felix Ramirez <br /> Contractor/Tank Tester License Number 08-1740 5-31 -23 <br /> ICC NumberICCICC Expiration Date <br /> 11/06/2022 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Franklin Fueling - EBW & Phil Tite #1009883708 12/28/2022 <br /> OPW #104634 3/17/2022 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> PEI 100 LAKE TEST <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> I hereby certify that each spill container was tested in accordance with California Code of <br /> Regulations, title 23, division 3, chapter 16, section 2637.1; that required supporting <br /> documentation is attached; and all information contained herein is accurate. I understand <br /> that test procedures shall be made available upon request by the governing authority. <br /> Service Technician Signature Date 00-30-2021 Total # of Pages <br /> F�� �� <br /> a 2 <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council <br /> Page 1 of 2 <br />
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