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COMPLIANCE INFO_2022
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0527629
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COMPLIANCE INFO_2022
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Entry Properties
Last modified
7/1/2022 10:58:11 AM
Creation date
3/3/2022 10:27:08 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2022
RECORD_ID
PR0527629
PE
2351
FACILITY_ID
FA0018721
FACILITY_NAME
Costco Wholesale #1031
STREET_NUMBER
2440
STREET_NAME
DANIELS
STREET_TYPE
ST
City
MANTECA
Zip
95337
CURRENT_STATUS
01
SITE_LOCATION
2440 DANIELS ST
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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Underground Storage Tank <br />Spill Container Testing Report Form <br />6. SPILL CONTAINER DETAILS <br />Test Method Developed by ® Manufacturer ® Industry Standard ❑ Professional Engineer <br />Test Type ❑ Pressure ❑ Vacuum ® Hydrostatic <br />Tank ID <br />T1 87A Fill <br />T2 87B Fill <br />T3 91 Fill <br />T4 Additive <br />Spill Container Manufacturer: <br />Phil-Tite <br />Phil-Tite <br />Phil-Tite <br />OPW <br />® Nonmetallic <br />® Nonmetallic <br />® Nonmetallic <br />® Nonmetallic <br />Method of Cathodic Protection <br />❑ Other <br />❑ Other <br />❑ Other <br />❑ Other <br />Is the spill container minimum <br />® Yes <br />® Yes <br />® Yes <br />® Yes <br />capacity five gallons excluding <br />❑ No* <br />❑ No* <br />❑ No* <br />❑ No* <br />riser volume? <br />® Drain <br />® Drain <br />® Drain <br />® Drain <br />Method to keep spill container <br />❑ Pump <br />❑ Pump <br />❑ Pump <br />❑ Pump <br />empty <br />❑ Other <br />❑ Other <br />❑ Other <br />❑ Other <br />® Pass <br />® Pass <br />® Pass <br />® Pass <br />Spill Container Test Results <br />❑ Fail <br />❑ Fail <br />❑ Fail <br />❑ Fail <br />Tank ID <br />Spill Container Manufacturer: <br />❑ Nonmetallic <br />❑ Nonmetallic <br />❑ Nonmetallic <br />❑ Nonmetallic <br />Method of Cathodic Protection <br />❑ Other <br />❑ Other <br />❑ Other <br />❑ Other <br />Is the spill container minimum <br />❑ Yes <br />❑ Yes <br />❑ Yes <br />❑ Yes <br />capacity five gallons excluding <br />❑ No* <br />❑ No* <br />❑ No* <br />❑ No* <br />riser volume? <br />❑ Drain <br />❑ Drain <br />❑ Drain <br />❑ Drain <br />Method to keep spill container <br />❑ Pump <br />❑ Pump <br />❑ Pump <br />❑ Pump <br />empty <br />❑ Other <br />❑ Other <br />❑ Other <br />❑ Other <br />❑ Pass <br />❑ Pass <br />❑ Pass <br />❑ Pass <br />Spill Container Test Results <br />❑ Fail <br />❑ Fail <br />❑ Fail <br />❑ Fail <br />8. COMMENTS <br />Describe all answers marked "Other, " "No, " or "Fail" and each proposed remedy. <br />* Mark here if: <br />❑ Spill containers do not have a minimum capacity of five gallons and require replacement. <br />Additional copies of this page may be attached. <br />Page 2 of 2 <br />
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