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INSTALL_2023
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0548528
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INSTALL_2023
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Last modified
11/4/2024 2:43:27 PM
Creation date
8/24/2023 12:57:59 PM
Metadata
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Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
INSTALL
FileName_PostFix
2023
RECORD_ID
PR0548528
PE
2351
FACILITY_ID
FA0000370
FACILITY_NAME
ORLANDOS ESCALON
STREET_NUMBER
2226
STREET_NAME
JACKSON
STREET_TYPE
AVE
City
ESCALON
Zip
95320
APN
22727016
CURRENT_STATUS
01
SITE_LOCATION
2226 JACKSON AVE
P_LOCATION
06
P_DISTRICT
005
QC Status
Approved
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XERXES TANK INSTALLATION CHECKLIST <br /> The tank owner should retain a copy of the completed Tank Installation Checklist in order to facilitate any warranty claim.Unless other <br /> information is requested,initial each step to verify that the item has been performed or installed per Installation Manual specifications <br /> and instructions. <br /> Al.GENERAL INFORM TION n ' <br /> Date of Installation _ <br /> Address of Installation C�,'1 f��S3� <br /> Tank Owner Name V U GIYYII (�{ Telephone I��^ /0�--1p (Email (�,bl/�ou tAOjmaf�Ke� Cbz�� <br /> Address ovt <br /> Contractor Name e Y� I If Belephone I��✓IG� E <br /> mail 1cgmner i4e <br /> Adoress <br /> A2.TANK INFORMATION <br /> Tank Number Tank#1 �C Tank#2 (0(C_ Tank#3 Tank#4 <br /> UL#(from tank label) (� <br /> 0-1 <br /> Nominal Tank Diameter(in feet)& I n,l �D ,DI (V�ppp (btbOC� <br /> Capacity(in gallons) lti <br /> Tank Type( OWS, <br /> Wet <br /> Other,and Wet orr D Dry)y) <br /> A3.PREINSTALLATION (See SECTIONS 2 and 3 for instructions and specifications.) <br /> Visual Inspection(no damage) <br /> NU Dammc <br /> Tanks shipped under vacuum t ) /� � <br /> (SECTION 4.3.requirements met) <br /> Tanks with monitoring fluid (In if 3 g I f <br /> (record fluid level in reservoir and check 4 <br /> for absence of fluid in or on tank) <br /> Tank passed pressure/soap test if req'd N <br /> A4,DIAMETER MEASUREMENTS(See SECTION 11 for instructions and requirements.Mark location of measurements on site sketch.) <br /> Measurement#1 (before installation) 3 g I��IX <br /> �/g <br /> Measurement 42(straps installed) (f3 1!q1`� <br /> Measurement#3(backfilled to top of tank) 12 1'4 t lI 1iq1 , �O !n,moi l l n^ i <br /> Measurement#4(backfilled to subgrade) t I 1/g <br /> I NJ !l ell <br /> Deflection measurement(#1—#4) 1 �L O g 3 g <br /> Measurement meets req'ts of TABLE 11-1 <br /> A5.INSTALLATION(See SECTIONS 5,6, 7,8, 9, 12 and 14 for instructions and specifications.) <br /> Primary backfill material <br /> Secondary backfill material(if used) IaJ N `'ter <br /> Traffic loads(indicate yes or no) <br /> Excavation(size and condition) J� 3 <br /> Hole condition(indicate dry or wet) <br /> Backfill bedding <br /> Tank spacing(between tanks and ;12-71Lf f <br /> from excavation walls) ✓� <br /> Anchoring(indicate system used: �J <br /> none,deadmen or anchor slab) GYi�[ {� <br /> Anchoring(if used) <br /> 30 <br />
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