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COMPLIANCE INFO_2021
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0527629
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COMPLIANCE INFO_2021
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Last modified
12/29/2021 4:41:42 PM
Creation date
5/10/2021 9:25:10 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
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\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 ID" as labeled in system <br />programming. Additional copies of this page may be attached to accommodate all sensors tested. <br />Sensor lD <br />Sensor Model <br />Component(s) Monitored <br />Pass <br />Fail <br />s25 <br />332117 <br />87A Product Line (Vacuum) <br />® <br />❑ <br />s27 <br />332117 <br />87A Vent Line (Vacuum) <br />® <br />❑ <br />s29 <br />332117 <br />87A Siphon Line (Vacuum) <br />® <br />❑ <br />s28 <br />332117 <br />87B Product Line (Vacuum) <br />® <br />❑ <br />s30 <br />332117 <br />87B Vent Line (Vacuum) <br />® <br />❑ <br />s26 <br />332117 <br />87A Vapor Line (Vacuum) <br />® <br />❑ <br />s31 <br />332117 <br />91 Product Line (Vacuum) <br />® <br />❑ <br />s32 <br />332117 <br />91 Vent Line (Vacuum) <br />® <br />❑ <br />s33 <br />332117 <br />Additive Product Line (Vacuum) <br />® <br />❑ <br />s34 <br />332117 <br />Additive Vent Line (Vacuum) <br />® <br />❑ <br />s18 <br />857080-112 <br />87A STP Sump <br />® <br />❑ <br />s20 <br />857080-112 <br />87B STP Sump <br />® <br />❑ <br />s22 <br />857080-112 <br />91 STP Sump <br />® <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />Describe all answers marked "No" or "Fail" and proposed remedy in Section 9. <br />List all monitoring equipment either replaced or repaired in Section 9 <br />Page 3 of 6 <br />
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