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COMPLIANCE INFO_2020
Environmental Health - Public
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EHD Program Facility Records by Street Name
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MOSSDALE
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2300 - Underground Storage Tank Program
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PR0231692
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COMPLIANCE INFO_2020
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Last modified
12/22/2020 9:25:12 AM
Creation date
6/11/2020 3:51:43 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2020
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
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SJGOV\kblackwell
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EHD - Public
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RECEIVED <br /> 1. TANK CONTAINMENT (Annular) <br /> Company Name: B.Z. Service Station Maintenance l�NN414ONMENIAL HEALTH <br /> Company Address: 1041 Triangle Ct.,West Sacramento,CA 95605 IlF 11'A HIM ENI <br /> Credentials: ®CSLB licensed Contractor ❑ SWRCB Licensed Tank Tester <br /> License Type: ICC License Number: 433159 <br /> Test Equipment Used: VACUUM GAUGE Equipment Resolution:0.5" <br /> Tank#All Tank# Tank# Tank# <br /> Wait time between applying <br /> pressure/vacuum/water and 5min <br /> starting test: _ <br /> 'I'est Start Time: 10:30 <br /> Initial Reading(Ri): 10" j <br /> Test End Time: 11:30 <br /> Final Reading(RF): <br /> Test Duration: 1 HR 1 HR 1 liR 1 HR <br /> Change in Reading(RF-Ri): 0 <br /> Pass/Fail Threshold or Criteria: 0 _ 0 0 0 <br /> Test Result: ® Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> Was sensor removed for testing? ®Yes❑No❑NA ❑Yes❑No❑NA ❑Yes❑No❑NA ❑ Yes❑No❑NA <br /> Was sensor properly replaced and ®Yes❑No❑NA ❑Yes❑No❑NA ❑Yes❑No[:]NA E] Yes❑No E]NA <br /> verified functional after testiq <br /> i <br /> st Equipment Used: VACUUM GAUGE Equipment Resolution:0.5" <br /> Tank# Tank# Tank# Tank# <br /> Wait time between Wndg <br /> pressure/vacuum/w <br /> startingtest: ---------- <br /> Test Start Time: <br /> Initial Reading(Ri) ------ <br /> Test End Time: <br /> Final Reading(RF) <br /> Test Duration: I HR I FIR 1 HR <br /> Change in Reading(RF-Rj): _.-- <br /> Pass/Fail Threshold or Criteria: 0 0 0 0 <br /> Test Result: E]Pass [I Fail El Pass [I Fall ❑Pass ❑ Fail ❑ Pass [I Fail <br /> Was sensor removed for testing? ❑Yes❑No❑NA ❑Yes❑No❑NA ❑Yes❑No❑NA ❑Yes❑No❑NA <br /> Was sensor properly replaced and ❑Yes❑No❑NA ❑Yes❑No❑NA ❑Yes❑No Q NA ❑Yes❑No Q NA <br /> verified functional after testing? 11 <br /> _Comments (include information on repairs made prior to testing and recommended follow-up for failed tests) <br /> With one inspector and two inspector trainees, conducted an annular vacuum test. All tests passed <br />
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