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COMPLIANCE INFO_2021
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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PR0231906
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COMPLIANCE INFO_2021
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Last modified
1/12/2022 4:38:57 PM
Creation date
1/11/2021 9:57:54 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0231906
PE
2361
FACILITY_ID
FA0003776
FACILITY_NAME
KWIK SERV LODI BW 113*
STREET_NUMBER
420
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
06202042
CURRENT_STATUS
01
SITE_LOCATION
420 W KETTLEMAN LN
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 /> Spill Container Testing Report Form <br /> 1. SPILL CONTAINER DETAILS <br /> Test Methods Developed by ❑ Manufacturer ® Industry Standard ❑ Professional Engineer <br /> Tank ID 87 91 DSL E85 <br /> Spill Container Manufacturer OPW OPW OPW OPW <br /> Method of Cathodic Protection ® Nonmetallic ® Nonmetallic ® Nonmetallic ® Nonmetallic <br /> ❑ Other ❑ Other ❑ Other ❑ Other <br /> Is the spill container minimum <br /> ® Yes ® Yes ® Yes ® Yes <br /> capacity five gallons excluding ❑ No* ❑ No* ❑ No* ❑ No* <br /> riser volume? <br /> Method to keep spill container ® Drain ® Drain ® Drain ® Drain <br /> empty ❑ Pump ❑ Pump ❑ Pump ❑ Pump <br /> ❑ Other ❑ Other ❑ Other ❑ Other <br /> Spill Container Test Results ® Pass ® Pass ® Pass ® Pass <br /> ❑ Fail ❑ Fail ❑ Fail ❑ Fail <br /> Tank ID Waste Oil <br /> Spill Container Manufacturer OPW <br /> Method of Cathodic Protection ® Nonmetallic ❑ Nonmetallic ❑ Nonmetallic ❑ Nonmetallic <br /> ❑ Other ❑ Other ❑ Other ❑ Other <br /> Is the spill container minimum ® Yes ❑ Yes ❑ Yes ❑ Yes <br /> capacity five gallons excluding ❑ No* ❑ No* ❑ No* ❑ No* <br /> riser volume? <br /> Method to keep spill container ® Drain ❑ Drain ❑ Drain ❑ Drain <br /> empty ❑ Pump ❑ Pump ❑ Pump ❑ Pump <br /> ❑ Other ❑ Other ❑ Other ❑ Other <br /> Spill Container Test Results ® Pass ❑ Pass ❑ Pass ❑ Pass <br /> ❑ Fail ❑ Fail ❑ Fail ❑ Fail <br /> 2. COMMENTS <br /> Describe all answers marked "Other" "No" or "Fail"and each proposed remedy. <br /> *Mark here if <br /> ❑ Spill containers do not have minimum capacity of five gallons and require replacement. <br /> Page 9 of 9 <br />
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