My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
COMPLIANCE INFO_2011-2018
Environmental Health - Public
>
EHD Program Facility Records by Street Name
>
W
>
WATERLOO
>
2512
>
2300 - Underground Storage Tank Program
>
PR0232418
>
COMPLIANCE INFO_2011-2018
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
11/21/2023 2:16:02 PM
Creation date
6/23/2020 6:55:41 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2011-2018
RECORD_ID
PR0232418
PE
2361
FACILITY_ID
FA0004064
FACILITY_NAME
WATERLOO LIQUOR
STREET_NUMBER
2512
Direction
E
STREET_NAME
WATERLOO
STREET_TYPE
RD
City
STOCKTON
Zip
95205
APN
14128102
CURRENT_STATUS
01
SITE_LOCATION
2512 E WATERLOO RD
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0232418_2512 E WATERLOO_2011-2018.tif
Tags
EHD - Public
Jump to thumbnail
< previous set
next set >
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
429
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
SWFCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed forr(t and <br /> printouts from tests(f applicable), should be provided to the facility owner/operator for Ubmittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: WATERLOO LIQUORS I Date of Testing: 4-4-17 <br /> Facility Address: 2512 E WATERLOO RD STOCKTON CA 95219 <br /> Facility Contact: Heng Phone: 209-463-4114 <br /> Date Local Agency Was Notified of Testing :3-17-17 <br /> Name of Local Agency Inspector(if present during testing): <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA TEST 416 2nd Street Galt,CA 95632 (209)744-0112 Fax:(209)744-0116 <br /> Technician Conducting Test: ❑Ed Stearns ❑ Zane A.Nimmo ® David A.Winkler ❑ Felix G.Ramirez <br /> 8184188. 5263322-UT 5263373-UT 5273934-UT <br /> Credentials: ®ICC Service Tech. ® SWRCB Tank Tester <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ® Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: h20 and tape measure Equipment Resolution: 1/16 <br /> Identify Spill Bucket(By Tank 1 87 2 91 3 DSL 4 <br /> Number, Stored Product, etc. <br /> ®Direct Bury E]Direct Bury <br /> Bucket Installation Type: ®Direct Bury ®Direct Bury F1 Contained in ❑Contained in <br /> E]Contained in Sump ❑Contained in Sump Sump Sum <br /> Bucket Diameter: I 1 11 11 <br /> Bucket Depth: 13 13 13 <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(TI): 1230 1230 1230 <br /> Initial Reading(R,): 13 12 13 <br /> Test End Time(TF): 130 130 130 <br /> Final Reading(RF): 11 12 13 <br /> Test Duration(TF—Ti): IHR IHR IHR <br /> Change in Reading(RF-Ri): 0 0 0 <br /> Pass/Fail Threshold or 1/16 1/16 1/16 <br /> Criteria: <br /> Test Result 11 ® Pass ❑Fail I ® Pass ❑Fail ® Pass ❑Fail ❑ Pass ❑Fait <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. <br /> Technician's Signature: Tc-�--j Date 4-4-17 <br /> State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements <br /> may be more stringent. <br />
The URL can be used to link to this page
Your browser does not support the video tag.