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INSTALL_2022
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0547762
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INSTALL_2022
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Last modified
8/26/2025 10:48:13 AM
Creation date
7/6/2022 9:54:17 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
INSTALL
FileName_PostFix
2022
RECORD_ID
PR0547762
PE
2351
FACILITY_ID
FA0027204
FACILITY_NAME
SAFEWAY FUEL CENTER #0055
STREET_NUMBER
19533
Direction
S
STREET_NAME
MOUNTAIN HOUSE
STREET_TYPE
PKWY
City
MOUNTAIN HOUSE
Zip
95391
CURRENT_STATUS
01
SITE_LOCATION
19533 S MOUNTAIN HOUSE PKWY
QC Status
Approved
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SJGOV\kblackwell
Tags
EHD - Public
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a <br /> TANK INSTALLATION CHECKLIST <br /> TO INSTALLER:After tank installation,del iverthe Installation Manual with the completed Tank Installation Checklist to theta nk owner.Retain a copy of <br /> each for your records. <br /> TO OWNER:After installation,retain the limited warranty,the Installation Manual and completed Tank Installation Checklist for future reference and to <br /> facilitate any warranty claim. Ij <br /> INSTALLATION DATE�S : PSONMPLETIG FORM: d9A <br /> INSTALLATION ADDRESS: Pou�Aa <br /> f u <br /> Tank type-Single-Wall(SW),Double-Wall(DW) <br /> Tank Usage(Fuel)-Fuel,DEF,Pipeline Sump <br /> { <br /> Tank Usage(Water)-Potable Water,Water Collection <br /> Tank Usage(Wastewater)--Grease Interceptor,Septic,Industrial Waste- <br /> water/Chemical <br /> Tank Usage(Oil/Water Separator) <br /> Nominal Tank Diameter-give in feet ` <br /> N. 5 <br /> Nominal Tank Capacity-give in gallons or liters(and note which) ML�s <br /> If applicable,UUULC#(read from tank label)-yes or no . <br /> S <br /> u <br /> $ v <br /> f <br /> r <br /> v <br /> Primary backfill meets Appendix C requirements-yes or no <br /> Secondary backfill material will be used--yes or no <br /> Secondary backfill meets our requirements-yes or no <br /> Geotextile will be used-yes or no <br /> Excavation-shored or not shored <br /> Tank will see traffic.loads(`H20or HS20)--yes or no <br /> Hole condition-dry or wet . <br /> Anchoring system will be used-yes or no J <br /> If applicable,anchoring system used-deadmen or anchor slab <br /> r " <br /> :^^„ <br /> Shipping damage-yes or no <br /> Cans of va.cu u rn--yes or no <br /> Monitoring fluid visible on interior of tank-yes or no. <br /> Monitoring fluid visible on exterior of tank-yes or noPP <br /> Requirements met for double-wall tanks shipped under interstitial <br /> vacuum-yes or no.If yes,record the value. <br /> Record fluid level in reservoir for double-wall wet tanks <br /> If required,tank passed pressure/soap test-yes or no <br /> AN C <br /> Y SHAWCOR <br />
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