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COMPLIANCE INFO_2023
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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REYNOLDS RANCH
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2680
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2300 - Underground Storage Tank Program
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PR0535432
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COMPLIANCE INFO_2023
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Entry Properties
Last modified
1/18/2024 2:54:38 PM
Creation date
5/5/2023 2:53:35 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2023
RECORD_ID
PR0535432
PE
2351
FACILITY_ID
FA0020431
FACILITY_NAME
COSTCO WHOLESALE #1091
STREET_NUMBER
2680
STREET_NAME
REYNOLDS RANCH
STREET_TYPE
PKWY
City
LODI
Zip
95240
CURRENT_STATUS
01
SITE_LOCATION
2680 REYNOLDS RANCH PKWY
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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ULTRAZQL0GA9058 <br /> Manufacturer's Affirmative Statement of Compatibility <br /> (As required by Califomia Cods of Regulations section 2631 (k)) <br /> (As required by Federal Regulation CFR Title 40, Chapter 1 , Subchapter 1 , Part 280. 32 (b)91 )(ii)) <br /> Component <br /> Supporting <br /> Manufacturer(s) Current UL Unique Identifiers for BlenTest Data & <br /> ( Including prior Model (. Type <br /> Standard Years to Sizes Field Evaluation (i.e. centr Documents <br /> marketed names) � n i Listing Manufacture color, material) Concentration Attached <br /> tank, etc. ) Yes/No <br /> Veeder-Root 859080.001 Line leak NIA N/A N/A None 10096 No <br /> 848480.001 Detector <br /> Veeder-Root 846397-601 Inventory NIA N/A 4' None 10096 No <br /> Probe <br /> Veeder-Root 857280-100, 200, 30x Vacuum N/A N/A N/A None 10096 No <br /> 3300204xx or Sensor <br /> 332175.001 ' <br /> Veeder-Root 0794380-323 Sump Sensor WA N/A NIA None 100% No <br /> i <br /> i Nestler-Root 0857080-111 Sump Sensor NIA N/A IT None 100% No <br /> 0857080-112 24' <br /> For tanks and piping please list only double wall products <br /> (Insert a company logo below if available) <br /> tf� I VEMER-ROOT <br /> Manufacturer. Veeder-Root <br /> Address: 125 Powder Forest Drive <br /> Simsbury, CT 06070 <br /> Phone: 916 715=9400 <br /> Email: demmington@veeder oom <br /> I declare, to the best of my knowledge and belief, that this affirmative statement of compatibRity and the information contained herein is true, correct, and complete. <br /> David Emmington Environmental Product Manager <br /> Print Name Title <br /> 0000t ~�?y/�� <br /> manT ers Authorized Signature —� Date <br /> 412023 <br />
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