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INSTALL 2001
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0231211
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INSTALL 2001
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Last modified
5/22/2019 11:32:25 AM
Creation date
5/15/2019 11:44:04 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
INSTALL
FileName_PostFix
2001
RECORD_ID
PR0231211
PE
2371
FACILITY_ID
FA0002409
FACILITY_NAME
SAFEWAY FUEL CENTER #2707
STREET_NUMBER
6425
Direction
N
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
CURRENT_STATUS
01
SITE_LOCATION
6425 N PACIFIC AVE
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
Scanner
KBlackwell
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EHD - Public
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i. -j tri r <br /> CERTIFICATE OF comft "' <br /> ETION <br /> J el <br /> Interstitial Vaccum Test (IVT) <br /> For The <br /> PLASTEELO Double-Wall Underground Tank <br /> all <br /> "1. 1. Third Party Evaluation: This leak tightness Installation Location: <br /> test method has been third party evaluated per the <br /> Alternate EPA Test Protocols for Plasteel Inc. The <br /> third party environmental consulting firm that per- <br /> formed the evaluation was: A" <br /> Ken Wilcox Associates, Inc. <br /> 9 i rs 19401 E. 40 Highway, Suite 100 <br /> Independence, MO 64055 IV. Test Results: The interstitial vacuum test was <br /> R9 (816) 795-7997 performed per Appendix B. The following data was <br /> recorded: <br /> 11 A copy of the evaluation is on file at each authoriz- Nominal Tank Capacity: <br /> 13". ed PLASTEELO tank manufacturer and at: (Gallons) <br /> Primary Tank Product: <br /> Plasteel Inc. <br /> ii <br /> 1189 Industrial Ave. (air, gasoline, diesel, water) <br /> Escondido, CA 92029 Required Test Period:(619) 745-0333 (Hours, per Appendix B, Figure 6.0) <br /> Initial Gauge Reading: -inches Hg. <br /> 11. Tank Description: <br /> Date - Time am/pm <br /> 2J 151 Capacity: Gallons Final Gauge Reading: - inches Hg. <br /> 51 0 <br /> .7o111_. Date - Time am/prn <br /> 0 FS Jacketed: Total Elapsed Time Period: <br /> Nt Composite: (Hours) <br /> Al. Pass Fail (Initial) <br /> Compartmented: Yes No I certify that the <br /> v. statement of Test: <br /> .ri 7i <br /> 7i; U.L. Number PLASTEELO Double-Wall tank described above has <br /> TO been tested leak tight per Appendix B of the <br /> §1 PLASTEELe Tank installation Instructions. <br /> Tank Zvlanufacturer: Testing Company: <br /> Ji <br /> RKSII Name: Name: <br /> FENI Address: Address: <br /> Ill. installation Information: Telephone: <br /> Tank Owner: Signature <br /> Name: <br /> Printed Name <br /> Address: <br /> Title <br /> Date <br /> V!Jl <br /> IVT-CERT 694 <br /> A <br />
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