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COMPLIANCE INFO_2003-2008
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0231216
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COMPLIANCE INFO_2003-2008
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Last modified
12/4/2023 2:32:22 PM
Creation date
6/3/2020 9:46:14 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2003-2008
RECORD_ID
PR0231216
PE
2361
FACILITY_ID
FA0002480
FACILITY_NAME
SHOP N GO 3
STREET_NUMBER
4511
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
11023011
CURRENT_STATUS
01
SITE_LOCATION
4511 PACIFIC AVE
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231216_4511 PACIFIC_2003-2008.tif
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EHD - Public
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AFFORDA-TE$T 416 2nd Street Galt CA 95632 Spill Bucket <br /> (209) 744-0112 (209) 744-0116 FAX Test Report <br /> TESTDATE —� <br /> r �/ <br /> SITE NAME �� : t C All r , PHONE ( d ) <br /> ADDRESS14 + CONTACT: <br /> 0 Jv <br /> J <br /> Inspector: Present J Not Present <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ❑Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: Equipment Resolution: <br /> Identify Spill Bucket(By Tank 1 2 3 4 <br /> Number,Stored Product, etc) <br /> irect Bury irect Bury ❑Direct Bury ❑Direct <br /> Bucket Installation Type: Bury <br /> ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in S <br /> ump <br /> Bucket Diameter: <br /> Bucket Depth: <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): 1 i L'' <br /> Final Reading(RF): 13 a/ <br /> Test Duration(TF—TI): O U r <br /> Change in Reading`RF,-RO: <br /> Pass/Fail Threshold or 1 � *� <br /> Criteria: <br /> COmmelxts-{include information o re airs made prior to ng, and recommended follow-up for failed tests). <br /> C <br /> Test Water: Taken with tester ❑Left on site <br /> hereby certify that all the information contained in this report is true, <br /> accurate, and in full compliance with legal requirements. Technician:' Lyle D. Nimmo <br /> ICC#: 5249115-UT <br /> Signature: ` OTTL#: 97-1143 <br />
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