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COMPLIANCE INFO_2021
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0231074
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COMPLIANCE INFO_2021
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Last modified
12/22/2021 12:21:52 PM
Creation date
8/5/2021 8:17:01 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0231074
PE
2351
FACILITY_ID
FA0002541
FACILITY_NAME
7-ELEVEN INC #20632
STREET_NUMBER
4627
STREET_NAME
DA VINCI
STREET_TYPE
DR
City
STOCKTON
Zip
95207
APN
11002003
CURRENT_STATUS
01
SITE_LOCATION
4627 DA VINCI DR
P_LOCATION
01
P_DISTRICT
002
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 /> 6. SPILL CONTAINER DETAILS <br /> Test Method Developed by ❑ Manufacturer Z Industry Standard ❑ Professional Engineer <br /> Test Type ❑ Pressure ❑ Vacuum Z Hydrostatic <br /> Tank ID T3 RUL T4 PUL T5 DIE <br /> Spill Container Manufacturer oPw oPw OPw <br /> Method of Cathodic Protection ® Nonmetallic 0 Nonmetallic 0 Nonmetallic ❑ Nonmetallic <br /> Ll Other ❑ Other ❑ Other ❑ Other <br /> Is the spill container minimum Z yes Z Yes 0 Yes Ll Yes <br /> capacity five gallons excluding <br /> ❑ No* LJNo* LlNo* ❑[ No* <br /> riser volume? <br /> Method to keep spill container 0 Drain A Drain ADrain -1 Drain <br /> empty ❑ Pump ❑ Pump ❑ Pump ❑ Pump <br /> ❑ Other ❑ Other ❑ Other ❑ Other <br /> Spill Container Test Results ❑ Pass ❑ Pass 0 Pass ❑l Pass <br /> LJ Fail ❑ Fail ❑ Fail i❑F0 <br /> Tank ID <br /> Spill Container Manufacturer: <br /> Q Nonmetallic ❑ Nonmetallic Ll Nonmetallic L-1NonmetallicMethod of Cathodic Protection ❑ 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 /> ❑ Drain ❑ Drain ❑ Drain ❑l Drain <br /> Method to keep spill container ❑ Pump ❑ Pump ❑ Pump ❑ Pump <br /> empty g Other ❑ Other ❑ Other ❑ Other <br /> Spill Container Test ResuIts ❑ Pass ❑ Pass ❑ Pass ❑ Pass <br /> ❑ Fail ❑ Fail ❑ Fail ❑ Fait <br /> 8. COMMENTS <br /> Describe all answers marked "Other." "No,"or"Fail''and each proposed remedy. <br /> Mark here if: <br /> 0 Spill containers do not have a minimum capacity of five gallons and require replacement. <br /> Additional copies of this page may be attached. <br /> Page 2 of 2 <br />
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