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COMPLIANCE INFO_2020
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0527629
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COMPLIANCE INFO_2020
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Last modified
12/22/2020 10:05:05 AM
Creation date
7/20/2020 10:41:54 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2020
RECORD_ID
PR0527629
PE
2351
FACILITY_ID
FA0018721
FACILITY_NAME
Costco Wholesale #1031
STREET_NUMBER
2440
STREET_NAME
DANIELS
STREET_TYPE
ST
City
MANTECA
Zip
95337
CURRENT_STATUS
01
SITE_LOCATION
2440 DANIELS ST
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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SJGOV\gmartinez
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EHD - Public
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UNDERGROUND STORAGE TANK <br /> MONITORING SYSTEM CERTIFICATION FORM (Page 3 of 6) <br /> Monitoring Device Used Device Model # Monitoring Device Used Device Model # <br /> Vent/Transition Sump ID : Unleaded Vent Sump Vent/Transition Sump ID : Additive Vent Sum <br /> ® Sump Sensor 794380-323 E Sump Sensor 794380 -323 <br /> N VPH Sensor 794380-304 N VPH Sensor 794380 -304 <br /> UDC ID : 1 & 2 UDC ID : 3 & 4 <br /> E Electronic Sensor 794380-323 N Electronic Sensor 794380-323 <br /> E Mechanical Device OPW Shear Valve N Mechanical Device OPW Shear Valve <br /> N VPH Sensor 794380-304 E VPH Sensor 794380-304 <br /> UDC ID : 5 & 6 UDC ID : 7 & 8 <br /> N Electronic Sensor 794380-323 E Electronic Sensor 794380-323 <br /> N Mechanical Device OPW Shear Valve E Mechanical Device OPW Shear Valve <br /> E VPH Sensor 794380-304 E VPH sensor 794380-304 <br /> UDC ID : 9 & 10 UDC ID : 11 & 12 <br /> E Electronic Sensor 794380-323 E Electronic Sensor 794380-323 <br /> E Mechanical Device OPW Shear Valve N Mechanical Device OPW Shear Valve <br /> E VPH sensor 794380-304 N VPH Sensor 794380-304 <br /> UDC ID : 13 & 14 UDC ID : 15 & 16 <br /> E Electronic Sensor 794380-323 N Electronic Sensor 794380-323 <br /> E Mechanical Device OPW Shear Valve N Mechanical Device OPW Shear Valve <br /> E VPH Sensor 794380-304 N VPH Sensor 794380 -304 <br /> UDC ID : 17 & 18 UDC ID : 19 & 20 <br /> N Electronic Sensor 794380-323 N Electronic Sensor 794380 -323 <br /> E Mechanical Device OPW Shear Valve N Mechanical Device OPW Shear Valve <br /> E VPH Sensor 794380-304 E VPH Sensor 794380-304 <br /> UDC ID : 21 & 22 UDC ID : 23 & 24 <br /> N Electronic Sensor 794380-323 N Electronic Sensor 794380-323 <br /> N Mechanical Device OPW Shear Valve N Mechanical Device OPW Shear Valve <br /> E VPH Sensor 794380-304 N VPH sensor 794380-304 <br /> Other Monitored component ID : Other Monitored Component ID : <br /> ❑ Other (Specify in section Vll.) ❑ Other (Specify in section V11.) <br /> Other Monitored Component ID : Other Monitored Component ID : <br /> ❑ Other (Specify in section VII.) ❑ Other (Specify in section Vll.) <br /> Other Monitored Component 113 : Other Monitored Component ID : <br /> ❑ Other (Specify in section VII.) ❑ Other (Specify in section VII.) <br /> Include information for every underground storage tank component monitored by this monitoring system control panel. If the monitoring <br /> system control panel monitors more components than this form accommodates, additional copies of these pages may be attached. <br /> VII . COMMENTS <br /> Use this section to provide any additional comments about the inventory of the equipment certified. <br /> T4 Additive has a shared Fill and STP sump . Fill sump sensors are covered in Piping sump listing . <br /> ID = Identification, VPH = Vacuum/Pressure/Hydrostatic, UDC = Undervdispensercontainment <br />
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