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COMPLIANCE INFO_1986-1993
Environmental Health - Public
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EHD Program Facility Records by Street Name
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N
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99 (STATE ROUTE 99)
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25651
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2300 - Underground Storage Tank Program
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PR0231628
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COMPLIANCE INFO_1986-1993
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Last modified
11/19/2024 1:51:13 PM
Creation date
6/23/2020 6:50:13 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
1986-1993
RECORD_ID
PR0231628
PE
2361
FACILITY_ID
FA0003835
FACILITY_NAME
SMK CHEVRON
STREET_NUMBER
25651
Direction
N
STREET_NAME
STATE ROUTE 99
City
ACAMPO
Zip
95220
APN
00514120
CURRENT_STATUS
01
SITE_LOCATION
25651 N HWY 99
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231628_25651 N HWY 99_1986-1993.tif
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EHD - Public
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IN'I'RUC;HON FOR C OMP1,1efIN a 1 1I 1 'II' <br /> GENERAL INSFRUCITON& <br /> 1. One FORM "13"shall be completed for each tank for all NEW 11FR 1'F ,FERMr,I`C~ I NG1,S, ICEMOV I and/car any <br /> othc r TA K 1h11 )Ft 11G CHANGIL <br /> 2, This form should be completed by either the PE I` PP1 C.ANF or the LOCAL AGINCY UNDURGROUNDTANK <br /> 3. Please type or print clearly all requested information, <br /> 4. Use a hard point writ1m,instrument,you are making'3 collies.' <br /> i. Mark can 1,1 `) in thc bar ,a sst to thc; it„r,, na'i best desa i c-s irQ the farm is beim completed, <br /> �?. liad_�a L�.I)II or d`aetlaty c.aarae xfr >__rae f.artf,is�t;Rt.alte <br /> L '1"AxNK 1)I RI1yI10N-(X) I*I.,IIITi All, "i Id Bm� IF UNKNOWN <br /> A, Indicate o% cr;s tank ID a'}:- If there i,;a Uaank number that iF : by she owner to identify the tank(ex.A1170789). <br /> I3. Indicate t,.: name of lbe compatay'th<a% tc mufacturcd the maa3. :11; F/,-%ti MFG). <br /> , Indicate€,i=; year the tank was inslafle; { x. 1937). <br /> D) Indicate the tank capacity in gallons ev .`000 or 10,OW etc), <br /> IL TANK M.MITWIN <br /> A. L If MW)'t`OR VF:HIC'1.[i FUT,,'1..,check box'I and complete items 13&fw. <br /> 2.If not M017f.31I Wi41I<."LF: 1 UI;(:, check the appropriate box in section Aand compAute items II& D. <br /> B. Check the appropriate box. <br /> C. Check the rye:of NI T OR E RIC:'LI [IA..L(if boxI is checked in A). <br /> D. Print the chemical name of the hazardous substance stored in the tank and the C.A.aS4.;(Chemical Abstract Service <br /> number),if box 1 is;SOT checked in Ay <br /> III. TANK C 0 1;1.'1WC`1 100-ARK ONE I`1VM ONLY IN BOX A, 11,C <br /> 1, Check only one item in"1"Y111;OFYSd'FM, I"AtN :�eia'kTERIAL,Wn..,ZIOR LINING and CORROSION l'FC6`9TEC.. 1()N <br /> 2. If OTHER,print in the space provided, <br /> 1'k. PIPING INFORMNLION <br /> 1. Circle A if above gre'iund; circle 11 if unde;rg ountt, and circae bath if applicable, <br /> 2 If UNK�;i'WN,circle: or if 01111`II,print iia sp aces pro ided. <br /> 3. Indicate the LEAK i)i,1ECg110N systern(s)'used to comply with the monitoring requirement for the piping, <br /> L Indicate the LEAK DI.IECI"IC)N systern(s)used to comply with the monitoring requirements for the tank, <br /> I. INFORMA'nON ONTANK PERMANEMILY CUXSED IN PI CT, <br /> 1. S'1'TMriTED IWI`I; <br />
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