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COMPLIANCE INFO_2020
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0231309
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COMPLIANCE INFO_2020
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Last modified
11/30/2020 4:29:03 PM
Creation date
10/8/2020 7:37:50 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2020
RECORD_ID
PR0231309
PE
2361
FACILITY_ID
FA0003756
FACILITY_NAME
KISHIDA, GEORGE INC
STREET_NUMBER
1725
STREET_NAME
ACKERMAN
STREET_TYPE
DR
City
LODI
Zip
95240
APN
06219001
CURRENT_STATUS
01
SITE_LOCATION
1725 ACKERMAN DR
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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Underground Storage Tank <br /> Monitoring System Certification Form <br /> 6. SENSOR TESTING RESULTS <br /> List only sensors tested on date of this certification. List "Sensor I D"as labeled in system <br /> programming <br /> Tank ID: 1 <br /> Sensor ID Sensor Model Com onent sMonitored Pass Fail <br /> 1 Optic Annular ® ❑ <br /> 7 BX-1-5 STP Sump ® ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> Tank ID: 2 <br /> Sensor ID Sensor Model Component(s)Monitored Pass Fail <br /> 3 BX-1-5 STP Sump ® ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> Tank ID: <br /> Sensor lD Sensor Model Component(s) Monitored Pass Fail <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ <br /> Describe all answers marked "No"or "Fail"and proposed remedy in Section 9. <br /> List a#Monitoring equipment either replaced or repaired in Section 9. <br /> Page 3 of 8 <br />
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