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COMPLIANCE INFO_2023
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0231692
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COMPLIANCE INFO_2023
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Entry Properties
Last modified
7/5/2023 8:59:44 AM
Creation date
4/5/2023 8:04:40 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2023
RECORD_ID
PR0231692
PE
2361
FACILITY_ID
FA0000212
FACILITY_NAME
Mossdale Chevron
STREET_NUMBER
444
Direction
W
STREET_NAME
MOSSDALE
STREET_TYPE
RD
City
LATHROP
Zip
95330
CURRENT_STATUS
01
SITE_LOCATION
444 W MOSSDALE RD
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\kblackwell
Tags
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 87 91 DSL <br />Spill Container Manufacturer: <br />Method of Cathodic Protection <br />Is the spill container minimum <br />capacity five gallons excluding <br />riser volume? <br />Method to keep spill container <br />empty <br />Spill Container Test Results <br />II Tank ID <br />Spill Container Manufacturer: <br />Method of Cathodic Protection <br />Is the spill container minimum <br />capacity five gallons excluding <br />riser volume? <br />Method to keep spill container <br />empty <br />Spill Container Test Results <br />OPW <br />® Nonmetallic <br />® <br />Other <br />❑ <br />® <br />❑ <br />Yes <br />® <br />No* <br />❑ <br />Drain <br />❑ <br />Pump <br />® <br />Other <br />❑ <br />Pass <br />❑ <br />Fail <br />❑ Nonmetallic <br />❑ <br />Other <br />Other <br />❑ <br />® <br />Yes <br />❑ <br />No* <br />® <br />Drain <br />❑ <br />Pump <br />❑ <br />Other <br />® <br />Pass <br />IM <br />Fail <br />OPW <br />® Nonmetallic <br />® <br />Other <br />❑ <br />Yes <br />❑ <br />No* <br />® <br />Drain <br />❑ <br />Pump <br />❑ <br />Other <br />® <br />Pass <br />97 <br />Fail <br />❑ Nonmetallic <br />® <br />Other <br />❑ <br />Yes <br />® <br />No* <br />❑ <br />Drain <br />❑ <br />Pump <br />❑ <br />Other <br />® <br />Pass <br />Irl <br />Fail <br />OPW <br />® Nonmetallic <br />❑ <br />Other <br />® <br />Yes <br />87 <br />No* <br />® <br />Drain <br />❑ <br />Pump <br />❑ <br />Other <br />❑ <br />Pass <br />37 <br />Fail <br />❑ Nonmetallic <br />® <br />Other <br />❑ <br />Yes <br />❑ <br />No* <br />® <br />Drain <br />❑ <br />Pump <br />® <br />Other <br />❑ <br />Pass <br />® <br />Fail <br />8. COMMENTS <br />Describe all answers marked "Other, " "No, " or "Fail' and each proposed remedy. <br />❑ Nonmetallic <br />❑ <br />Other <br />❑ <br />Yes <br />❑ <br />No* <br />❑ <br />Drain <br />❑ <br />Pump <br />❑ <br />Other <br />❑ <br />Pass <br />❑ <br />Fail <br />❑ Nonmetallic <br />® <br />Other <br />❑ <br />Yes <br />❑ <br />No* <br />❑ <br />Drain <br />❑ <br />Pump <br />❑ <br />Other <br />❑ <br />Pass <br />11 <br />Fail <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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