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COMPLIANCE INFO_2001-2009
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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PR0231692
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COMPLIANCE INFO_2001-2009
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Last modified
12/28/2023 11:29:54 AM
Creation date
6/3/2020 9:51:14 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2001-2009
RECORD_ID
PR0231692
PE
2361
FACILITY_ID
FA0000212
FACILITY_NAME
Mossdale Chevron
STREET_NUMBER
444
Direction
W
STREET_NAME
MOSSDALE
STREET_TYPE
RD
City
LATHROP
Zip
95330
CURRENT_STATUS
01
SITE_LOCATION
444 W MOSSDALE RD
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231692_444 W MOSSDALE_2001-2009.tif
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EHD - Public
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SWRCB, January 2002 <br />Page 5 of 3— <br />Test Method Developed By: <br />❑ Sump Manufacturer 0 Industry Standard Professional Engineer <br />G Other (Spec) <br />Turbineshutdown response time <br />Test Method Used: <br />G Pressure <br />0 Vacuum <br />><Rydrostatic <br />Is system programmed for fail-safe <br />shutdown?' <br />0 Other (Spec') <br />es 0 No 0 NA <br />'es 0 No ENA <br />Test Equipment Used: C4 1dw <br />I i ,,tu CG <br />0 Yes , o 0 NA <br />Equipment Resolution: Q <br />0 Yes 0 0 NA <br />❑ Yes ";`0 No DNA <br />Wait time between_qpplying <br />pressure/vacuo water d starting <br />test: <br />Ip r1l 0,1 c4 <br />lb ref in <br />Sump # i . <br />Sump # <br />Sump # ' Sump # <br />Sump Diameter: <br />4 ' i <br />(.4 2. r. <br />Sump Depth: <br />Sump Material: <br />r,) <br />.2 � � <br />Height from Tank Top to Top of <br />P -a v5 -,t'ke <br />Highest Piping Penetration: <br />.fid rt iYr c4 P'rt <br />d All <br />Height from Tank Top to Lowest <br />fjo ?C, <br />e) <br />r <br />Electrical Penetration: <br />fl <br />Z 0 e ° <br />2.0 <br />/f <br />Condition of sump prior to testing: <br />1:),r <br />Pass 0 Fail <br />OPass 0 Fall <br />` <br />Portion of Sump Tested' <br />y� � rtr g- Zit `'JW <br />ct: ry9 Z -t °' <br />Vp - , <br />Cies ❑ No 0 <br />Does turbine shut down when <br />sump sensor detects l'au'd (both <br />Rites F1 Na n Na <br />n Nn n wa <br />n rid <br />9n a�� nun <br />nXT.. � Xr. <br />e. <br />product and water)?- <br />ater)?'Turbine <br />Turbineshutdown response time <br />f <br />Is system programmed for fail-safe <br />shutdown?' <br />es 0 No 0 NA <br />es 0 No 0 NA <br />'es 0 No ENA <br />0Y t No 0 NA <br />Was fail-safe verified to be <br />o erational?® <br />0 Yes , o 0 NA <br />0 Yes -Y. o 0 NA <br />0 Yes 0 0 NA <br />❑ Yes ";`0 No DNA <br />Wait time between_qpplying <br />pressure/vacuo water d starting <br />test: <br />Ip r1l 0,1 c4 <br />lb ref in <br />4.1 it <br />Test Start Time: <br />Initial Reading (Rr)�fGY�Is��_ <br />Test End Time: <br />.2 � � <br />s: <br />Final Reading (RF): <br />P -a v5 -,t'ke <br />Test Duration: <br />.fid rt iYr c4 P'rt <br />d All <br />Change in Reading (RF-Ri): <br />fjo ?C, <br />e) <br />Pass/Fail Threshold or Criteria: <br />LO 6=3 41 1 . <br />;>� �� �,� Fvr • <br />� „� a g i ,� ,.a,� , <br />Test Result: <br />Pass 0 Fail <br />Pass 0 Fail <br />OPass 0 Fall <br />01! Pass 0 Fa <br />Was sensor removed for testing? <br />es 0 No G NA <br />-Yes 0 No DNA <br />es 0 No 0 NA <br />Cies ❑ No 0 <br />Was sensor properly replaced and <br />verified functional after testing? es G No 0 NA es G No 0 NA >TYes G No G NA /Yes G No DNI <br />Comments — (include information on repairs made to testing and recommended follow-up fpr failed tests) <br />' if the entire depth of the stamp is not tested, specify how rnuch was tested. If the answer to 4ay of the questions indi�4,,-,d with an <br />;asterisk (*) is "NO" or "NA", the entire sump trust be tested. (See SWRCB LG -160) <br />
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