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COMPLIANCE INFO_2024
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0231532
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COMPLIANCE INFO_2024
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Entry Properties
Last modified
12/2/2024 8:39:05 AM
Creation date
1/31/2024 9:17:58 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2024
RECORD_ID
PR0231532
PE
2351 - UST FACILITY - 2481 COMPLIANT
FACILITY_ID
FA0000185
FACILITY_NAME
WAYZ FOOD & LIQUOR
STREET_NUMBER
16470
STREET_NAME
CAMBRIDGE
STREET_TYPE
DR
City
LATHROP
Zip
95330
APN
19643032
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\kblackwell
Supplemental fields
Site Address
16470 CAMBRIDGE DR LATHROP 95330
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 10779784 <br />Test Date 12/14/2023 <br />Facility Name WAYZ GAS & LIQUOR <br />Facility Address 16470 CAMBRIDGE ROAD <br />City <br />LATHROP P <br />ZIP de <br />95330 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Test <br />ECO - C H E K <br />Phone <br />888 -500 -CH EK <br />Mailing Address 3249 MT. D IABLO CT. LAFAYETTE , CA 94549 <br />Service Technician Performing Test <br />Zane Nimmo <br />Contractor/Tank Tester License Number 04-1676 EX. 4/30/2025 <br />ICC Number <br />8883064 -UT <br />ICC Expiration Date <br />5/27/2025 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />Franklin Fueling - EBW & Phil Tite #10009843708 <br />12/5/2024 <br />OPW #104-632 <br />3/14/2024 <br />4. TEST PROCEDURE INFORMATION <br />Test Procedures Used <br />Components Tested <br />LAKE TESTING <br />SPILL BUCKET, DRAIN VALVE AND ADAPTER <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 Sianature Date 12/14/2023 <br />Total # of Pages <br />2 <br />CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br />Council <br />Page 1 of 2 <br />
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