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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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2501
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2300 - Underground Storage Tank Program
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PR0231488
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
12/28/2021 10:47:59 AM
Creation date
5/4/2021 9:08:57 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0231488
PE
2361
FACILITY_ID
FA0003910
FACILITY_NAME
H&M - BW #98
STREET_NUMBER
2501
STREET_NAME
JACKSON
STREET_TYPE
AVE
City
ESCALON
Zip
95320
CURRENT_STATUS
01
SITE_LOCATION
2501 JACKSON AVE
P_LOCATION
06
P_DISTRICT
005
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 <br />® Industry Standard ❑ Professional Engineer <br />Tank ID <br />87 <br />91 <br />DSL <br />Spill Container Manufacturer <br />Philtite <br />Philtite <br />OPW <br />Method of Cathodic Protection <br />® Nonmetallic <br />® Nonmetallic <br />® Nonmetallic <br />❑ Nonmetallic <br />❑ Other <br />❑ Other <br />❑ Other <br />❑ Other <br />Is the spill container minimum <br />® Yes <br />® Yes <br />® Yes <br />❑ Yes <br />capacity five gallons excluding <br />❑ No* <br />❑ No* <br />❑ No* <br />❑ No* <br />riser volume? <br />Method to keep spill container <br />® Drain <br />® Drain <br />® Drain <br />❑ Drain <br />❑ Pump <br />❑ Pump <br />❑ Pump <br />❑ Pump <br />empty <br />❑ Other <br />❑ Other <br />❑ Other <br />❑ Other <br />Spill Container Test Results <br />® Pass <br />® Pass <br />® Pass <br />❑ Pass <br />❑ Fail <br />❑ Fail <br />❑ Fail <br />❑ Fail <br />Tank ID <br />Spill Container Manufacturer <br />Method of Cathodic Protection <br />❑ Nonmetallic <br />❑ Nonmetallic <br />❑ Nonmetallic <br />❑ Nonmetallic <br />❑ Other <br />❑ Other <br />❑ Other <br />❑ Other <br />Is the spill container minimum <br />❑ Yes <br />❑ Yes <br />❑ Yes <br />❑ Yes <br />capacity five gallons excluding <br />❑ No* <br />❑ No* <br />❑ No* <br />❑ No* <br />riser volume? <br />❑ Drain <br />❑ Drain <br />❑ Drain <br />❑ Drain <br />Method to keep spill container <br />❑ Pump <br />❑ Pump <br />❑ Pump <br />❑ Pump <br />empty <br />❑ Other <br />❑ Other <br />❑ Other <br />❑ Other <br />❑ Pass <br />❑ Pass <br />❑ Pass <br />❑ Pass <br />Spill Container Test Results <br />❑ Fail <br />❑ Fail <br />❑ Fail <br />❑ Fail <br />2. COMMENTS <br />Describe all answers marked "Other'; Wo'; 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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