My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
COMPLIANCE INFO_2003 - 2007
Environmental Health - Public
>
EHD Program Facility Records by Street Name
>
C
>
CHEROKEE
>
610
>
2300 - Underground Storage Tank Program
>
PR0521866
>
COMPLIANCE INFO_2003 - 2007
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
9/20/2021 3:49:10 PM
Creation date
11/2/2018 5:10:41 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2003 - 2007
RECORD_ID
PR0521866
PE
2371
FACILITY_ID
FA0014852
FACILITY_NAME
RANCHO SAN MIGUEL MARKET*
STREET_NUMBER
610
Direction
S
STREET_NAME
CHEROKEE
STREET_TYPE
Ln
City
Lodi
Zip
95240
APN
04745039
CURRENT_STATUS
01
SITE_LOCATION
610 S Cherokee Ln
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\wng
Supplemental fields
FilePath
\MIGRATIONS\C\CHEROKEE\612\PR0521866\COMPLIANCE INFO 2003 - 2007 .PDF
QuestysFileName
COMPLIANCE INFO 2003 - 2007
QuestysRecordDate
10/28/2016 6:58:12 PM
QuestysRecordID
3244411
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
125
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
Page 1 of 7 <br /> Secondary Containment Testing Report Form <br /> Thu form is intended for use by contractors performing periodic testing of UST secondary containment systems. Usethe <br /> appropriate pages of this form to report results for all components tested. The completedform, written test procedures, and <br /> printouts from tests(if applicable), should be provided to the facility owner/operator far.submittal to the local regulatory agency. <br /> 1. FACQdTV INFORMATION <br /> Facility Name: Rancho San Miguel Date of Testing: March 23,20M <br /> Facility Address: 610 South Cherokee Lane Lodi,Ca. WO#03-11109 Time: 8:00 am <br /> Facility Contact: Gilbert Silva Phone: (209)944-4577 <br /> Date Local Agency Was Notified of Testing: March 16.2006 <br /> Name of Local.Agency inspector(ifprecent during testing): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Franzen-Hill Corp 1100 North J Street Tulare.CA 93274 <br /> Technician Conducting Test: John Ellis <br /> Credentials: x CSLB Licensed Contractor - 111 SWRCB Licensed Tank Tester <br /> License Type: A,B,C-61ID40 HAZ License Number: 304147 <br /> i <br /> Manufacturer Trainine <br /> Manufacturer Component(s) Date Training Expires <br /> Environ Piping and Testing 12/07 <br /> Total Containment Piping.and TeLfipg 9/07 <br /> bacon Testin 11/07 <br /> Cadwell Testing <br /> 3. SUMMARY OF TEST RESULTS <br /> Component Pass Fail Not Repairs Component Pass Fail Not Repairs <br /> Tested Made Tested Made <br /> UDC !2 X X <br /> UDC34 X X <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> Water returned to the test trailer storage taink. <br /> CERTIFICATION OF TECHNICIAN RESPONSTRLE FOR CONDUCTING THIS TESTING <br /> To the best of my knowledge,the farts stated in this document are accurate and in full compliance with legal requirements <br /> Technician'sSignatur Date: 7 ,)�� <br />
The URL can be used to link to this page
Your browser does not support the video tag.