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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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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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5. UNDER-DISPENSER CONTAINMENT Ul)C TESTING <br /> Company Name: B.Z. Service Station Maintenance <br /> Company Address: 1041 Triangle Ct.,West Sacramento,CA 95605 <br /> Credentials: ®CSLB Licensed Contractor ❑ SWRCB Licensed Tank Tester <br /> License Type: ICC License Number: 433159 <br /> i <br /> Equipment Used: INCON TS-STS Equipment Resolution: 0.0001 <br /> iz <br /> UDC# UDC# UDC# UDC H <br /> Portion of UDC Tested' <br /> Does turbine shut down when <br /> UDC sensor detects liquid(both ❑Yes❑No❑NA ❑Yes❑No❑NA ❑Yes❑No❑NA Q Yes❑No Q NA <br /> product and water)?* <br /> Turbine shutdown response time <br /> Is system programmed for fail- ❑Yes❑No❑NA ❑Yes Q No❑NA ❑Yes❑No❑NA ❑Yes❑No❑NA <br /> safe shutdown?' <br /> Was fail-safe verified to be <br /> operational?* ❑Yes❑No❑NA E]Yes E]No[:1NA [-I Yes E]No❑NA ❑Yes[_1No E]NA <br /> Wait time between applying <br /> pressure/vacuum/water and <br /> starting test <br /> Test Start Time: <br /> Initial Reading(111): _ <br /> 'rest End Time: <br /> Final Reading RF): <br /> Test Duration: 15 MIN 15 MIN 15 MIN 15 MIN <br /> Change in Reading(RF-111): <br /> Pass/Fail Threshold or Criteria: 0.002 0.002 0.002 0.002 <br /> Test Result: Q Pass Fail Pass Fail Pass Fail ❑ Pass Fail <br /> Was sensor removed for testing? ❑Yes Q No 0 NA ❑Yes No NA Yes❑No❑NA Yes❑No Q NA <br /> Was sensor properly replaced and <br /> verified functional after testim,? E] Yes❑ No❑NA Q Yes❑No❑NA Q Yes E] No E]NA —Q Yes[I No❑NA <br /> RECEIVED <br /> SEP 04 2020 <br /> 1 NV11RONMENTAL HEALTH <br /> DEPARTMENT <br />
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