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COMPLIANCE INFO_2003
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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PR0507204
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COMPLIANCE INFO_2003
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Last modified
2/16/2021 3:57:05 PM
Creation date
6/23/2020 6:58:01 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2003
RECORD_ID
PR0507204
PE
2361
FACILITY_ID
FA0007735
FACILITY_NAME
7-ELEVEN INC #32262
STREET_NUMBER
2360
Direction
W
STREET_NAME
GRANT LINE
STREET_TYPE
RD
City
TRACY
Zip
95376
APN
23819001
CURRENT_STATUS
01
SITE_LOCATION
2360 W GRANT LINE RD
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0507204_2360 W GRANT LINE_2003.tif
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EHD - Public
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XERXES@ TOK INSTALLATION <br /> CORPORATION Fiberglass Underground Storage Tanks <br /> Single-Wall(SWT), Double-Wali(DV'JT), Muiticompartment(MCT)and Oil/Water Separators(OWS) <br /> Complete this checklist,and keep it with copies of any written authorizations for variations andlor deviations received from Xerxes. <br /> • Date of Installation 69" ' 7— C> Tank Size and Capacity iS� <br /> • Tank Type SWT DWT MONITORING-FLUID DRY MOT OWS (Circle those that apply.) UL Number Z <br /> Slte er7—E! c l X-ftia. Z ZZ@ 2. <br /> Site Address ey c <br /> C <br /> • <br /> Installing Contractor rr <br /> On-Site Srapervdsor � ( � a t(F�"T A4 7110 f` � uke t � <br /> • ➢ e Verified by <br /> A. Visual Inspection:No evidence of damage(toles,cracks,gouges)in tank.(Document any damage found.)...................................... <br /> S. nitoring-Rind Tanks: f.Ct*ck and record monitoring-fluid level in reservoir. .......................................... <br /> 2. for monitoring fluid inside and outside of tank. ..... .. ...... <br /> C. Physical Tact: Preinstallation air/soap test completed in accordance with ir*U latlon instructions... ..... ......... . ..... <br /> D. BackfillMaterial, (Indicate which type.) 1.Pea gravel orcrusibed stone as spedfledbyXERXES........: <br /> 2:other(Requires specific approval by XERXES describe) ....................... <br /> E. Excavation: Hole dimensions are correct per installation Instructions for appropriate conditions..... ......... ................................ <br /> F Internal DiameterMeasurarnsift.Tre of tankis and in Sedw 4 belrnnr}.... <br /> 6. Geatextile Utilized: (Indicate one.) Yes 2.No ......... ............................................................................... ....................... <br /> H. a Con n: (indicate one.) t.Dry dole(Water is not anticipated to reach tank—area is not subject to flooding.)............... <br /> SOPS <br /> at (Excavation may trap water area is subject to flooding) ........... <br /> I. Tmffic Loads: (indicate one.) Tra loads antics ..................................... <br /> 2.No traft loads anticipated .....I.. ......................................... <br /> J. Nn : <br /> Performed in accordance Installation in s. , adrne 2.Full slab.. ....... ........ L T <br /> K. Fittings and Other Metal Components: Coated to protect against corrosion. ........................ ... <br /> + Verified by: <br /> bed is level Is a mdninuim of 12 Inches.deep,.over a soil or slab,before setting tank ...................... <br /> B. Tank Spacing: Tanks are spaced correctly from each other and from excavation according to Instructions tions......................................... <br /> C. Visual Inspection. No evidence of damage is found after setting In hole ........ .................................................................... <br /> D. Hold-down Straps: Positioned and secured according to instailat'ion Instructions_(See SECTION 6.4.of IrWalleflon Manual)......... <br /> E. Backlin Compacted: Material has been tamped andior compacted to fill all voids around tank...... ........................................I...... <br /> F. Tank Is pro ballasted during backfilling: (vet-hole liftilt8billon only)....... ........ <br /> C. Taok(s)are buried of p depth to conform to appropriate conditions: (wet,dry,traffic or no traffic)......... . ...... <br /> a • Verified by: <br /> A. Physical Test: Airlsoap test is completed according to installiatlon Instructions................................................................................... <br /> EL krIiWWDWfflWMeWjWMt The' ofttoetsk*s .&.d 4bebw} .... <br /> C. ftoring-Fluid Tanks: 1.Check and record monit ll level in the reservoir % (inches)....... .. ....... . ..... <br /> 2.Check for monitoring fluid inside tank. .... ..................I.......... <br /> D. Installation Manual: Deliver Installation Manual and operating Guidelines to owner. : . .. .... ..... .... <br /> INt • <br /> All tanks must be measured to determine vertical.deftedon. Follow deft asurement instructions(Section 14)in the Installation Manual. An <br /> initial intemaWiameter measurement is taken and recorded as a point of reference. Subsequent internal-diameter measurements show tank deflection and <br /> can be compared to the table below.Take each measurement from the same fitting using the same procedure, <br /> Ntf CENTER ND <br /> External Tank INTERNNAL-DIAMETER MEASUREMENTS <br /> Diameter 4 6 8 10 12 initial Intemal Diameter(before backfiiting) <br /> Final€ntemol Diameter(after backfihing) <br /> AllowableInitial tntemal Diameter minus <br /> - 6 f i !. ➢ ➢ Y i ➢ t➢ 11 18 <br /> Defl <br /> ectlon 112 314 1-114 11-112 1-3I4 Final Inte brie rWfi Mark the tocatron where intima diameter <br /> (In.p Verified by: oe measurements were taken. <br /> 27 <br />
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