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COMPLIANCE INFO_2022
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BENJAMIN HOLT
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2300 - Underground Storage Tank Program
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PR0506497
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COMPLIANCE INFO_2022
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Last modified
10/10/2022 9:32:56 AM
Creation date
7/28/2022 2:20:02 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2022
RECORD_ID
PR0506497
PE
2351
FACILITY_ID
FA0007461
FACILITY_NAME
7-ELEVEN INC #14113
STREET_NUMBER
3040
Direction
W
STREET_NAME
BENJAMIN HOLT
STREET_TYPE
DR
City
STOCKTON
Zip
95219
APN
10027018
CURRENT_STATUS
01
SITE_LOCATION
3040 W BENJAMIN HOLT DR
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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Appendix VI <br /> Underground Storage Tank <br /> Monitoring System Certification Form <br /> TYPE OF ACTION F71 Installation ❑/ Repair ❑ 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Certification Date <br /> 10165777 08/10/2022 <br /> Facility Name <br /> 7-ELEVEN INC.#14113 <br /> Facility Address City ZIP Code <br /> 3040 W Benjamin Holt Stockton 95219 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification Phone <br /> Service Station Systems, Inc. (408)971-2445 <br /> Mailing Address <br /> 680 Quinn Ave San Jose CA 95112 <br /> Service Technician Performing Test <br /> Steven Ingraham <br /> Contractor/Tank Tester License Number <br /> 485184 <br /> ICC Number ICC Expiration Date <br /> 10193405 03/28/24 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Veeder Root#C31685 07/19/2024 <br /> Franklin Fueling#1006623714 03/30/2024 <br /> Vaporless#5219/5220 07/28/2024 <br /> 4. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> I hereby certify that the monitoring system is operational in accordance with California Code <br /> of Regulations, title 23, division 3, chapter 16, section 2638; that required supporting <br /> documentation is attached; and all information contained herein is accurate. <br /> Service Technician Signature Date Total # of Pages <br /> 08/10/2022 6 <br /> CERS = California Environmental Reporting System, GPH = Gallons Per Hour, ID = Identification, <br /> ICC = International Code Council, LLD = Line Leak Detector, NA = Not Applicable, SW = Single- <br /> Walled, UDC = Under-Dispenser Containment, UST = Underground Storage Tank, <br /> VPH = Vacuum/Pressure/Hydrostatic <br /> Page 1 of 6 <br />
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