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COMPLIANCE INFO_2002-2009
Environmental Health - Public
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EHD Program Facility Records by Street Name
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COUNTRY CLUB
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2300 - Underground Storage Tank Program
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PR0231069
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COMPLIANCE INFO_2002-2009
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Last modified
2/27/2023 4:51:25 PM
Creation date
6/3/2020 9:44:40 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2002-2009
RECORD_ID
PR0231069
PE
2361
FACILITY_ID
FA0001909
FACILITY_NAME
STOP N SHOP
STREET_NUMBER
1856
Direction
W
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
123-191-02
CURRENT_STATUS
01
SITE_LOCATION
1856 W COUNTRY CLUB BLVD
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231069_1856 W COUNTRY CLUB_2002-2009.tif
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EHD - Public
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v 0 0 <br />416 2nd Street Galt CA 95632 Spill Bucket <br />AFFORDA-TE$T <br />20 744-0112 (209) 744-0116 FAX Test Report <br />TEST DATE <br />/15 /6 -7 - <br />NAME 64rWrla-l' /�C-zp .10�ez__ PHONE ( 2- Cc) <br />ADDRESS CONTACT: <br />4M4e4 <br />chi tJ C�' Present Not Present <br />3. SPELL BUCKET TESTING INFORMATION <br />Test Method Used: KHydrostatic D Vacuum D Other <br />Test Equipment. Used: —1 1=1 P E -Equipment Resolution: /1 <br />Identify Spill Bucket (By Tank 1 <br />Number, Stored Product, etc) <br />2 3 <br />4 <br />3 <br />Bucket Installation Type: )(Direct Bury <br />0 Contained in S <br />KDirect Bury 0 Direct Bury <br />D Contained in Sump 0 Contained in Sump <br />0 Direct Bury <br />0 Contained in Sump <br />Bucket Diameter: <br />Bucket Depth: <br />1.5 V2— <br />Wait time between applying <br />vacuum/water and start of test: <br />Test Start Time (TO: <br />Initial Reading (RI): <br />Test End Time (TF): <br />Final Reading (RF): <br />H <br />Test Duration (TF — TI): <br />Change in Reading (RF - RI): <br />Pass/Fail Threshold or <br />WAN <br />.Comments —. (include informatidnIon repairs made prior ting, and recommended follow-up forfailed tests) <br />Test Water:.+qq'Taken with tester E] Left on site <br />I hereby certify that all the information contained in this report is true, <br />accurate, and in full compliance with legal requirements. Technician-- Zane A. Nimmo <br />ICC #: 5263322 -UT <br />Signature: OTTL #: 04-1676 <br />
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