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UST COMPLIANCE CHECKLIST <br /> Station Number:!>P Station Address: SY�ti'�tk {� Parcel #: <br /> _ , <br /> I'VED <br /> Project Manager: General Contractor: <br /> Green Site: r_1 Modification of Existing Facility: F-1F L� 0 5 2020 <br /> Target Ground Break: Target Opening: Tank Install Date: <br /> Facility Type: R",Extra Mile Car Wash ❑�� ENVIRONMENTAL HEALTH <br /> DEPAPTMENT <br /> Operator: ❑ COCO F-1CORO DBA: <br /> Chevron Property: ❑ Leased Land Property Owner ❑ <br /> If Land Leased-Lessor Info <br /> Name <br /> Street Address <br /> City/State/Zip Phone t <br /> Equipment Manufacturer I Model Number/Type Other Info <br /> Tanks D-existing ❑ New <br /> 'CV-5 Size: <br /> ------------------------------- - -- -------------------------------------------------- ---------------------------------------- <br /> • MG Size: <br /> --------------------------------------------- ------ --------------- -------------------------------- ---------------------------------------- <br /> • PU Total Size: <br /> Multi-Compartment: PrimaryQ' If MCT Primary Size <br /> .p------------------- ------- - ------------------------------ ------------------ - - <br /> D�/F , End Tank Size <br /> Multi-e-ompartment: End c7 K <br /> Vapor Recovery System Type v' - <br /> Tank Annular Space Sensor if p2&f w-}- Dry ❑or Brine' <br /> Tank Level Monitor <br /> Product Lines (, <br /> Dispensers ElExisting 0 New #of Dispensers <br /> Total#of Nozzles /G <br /> Monitoring SystemDedicated Modem E] <br /> t�'� LJ Modem Number <br /> Dispenser Sumps If Double Containment Yes <br /> • Primary Sump Sensors f,�t�< < {�U, U Secondary Model #; <br /> -Turbine Sum SIf Double Containment LJ Yes <br /> • <br /> Primary Sump Sensors V�' ��.t �- Secondary Model # <br /> Fill SumpsIf Double Containment 0 Yes <br /> --------- ----- - ' � - <br /> • Primary Sump Sensors VLA �� a,-{ 74i Secondary Model # <br /> Line Leak Detection nn Interstitial monitoring <br /> Method <br /> Spill Containment <br /> • Fill Gal Size: <br /> G'� ------- - - <br /> -- --- --------------- --- ------------------------------ <br /> Vapor ❑ Gal Size: <br /> Mechanical PSQ- Set % of Tank: <br /> Overfill ;-drop �'ube o <br /> oa--- --------i ----------------- 95/o <br /> Ball oa ---------------------------------- --Prevention w/Extemal ❑ 90% <br /> AudibleNisual Alarm <br /> Please submit to: permitdesk(a-)-chevron.com or Fax to: 925-842-9585 <br />