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PV II It, <br />c= SAN JOAQUIN COUNTY <br />€ ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd <br />C. <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />Valley Pacific Fresno Cardlock <br />Wednesday, October 17, 2012 <br />Facility Address: <br />Service Request #: <br />1524 Fresno Ave., Stockton <br />SR0064613 <br />Onsite Service Technician's Name: <br />ICC Service Technician/Installer Exp. Date: <br />Manufacturer Training: <br />Josh Simmons <br />9/20/13 <br />Incon x. 12/16/12 <br />SERVICE <br />SERVICE <br />Leak detector <br />Spill bucket ❑minimum 5 gallon <br />❑ <br />El mechanical Model: <br />El <br />-1hour hydrostatic ❑ Incon TS -STS <br />❑ electronic Serial #: <br />❑ Caldwell System ❑ Other <br />❑ line test programmed <br />Leak detector <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ mechanical Model: <br />El <br />El hour hydrostatic ❑Incon TS -STS <br />❑electronic Serial #: <br />❑Caldwell System ❑Other <br />❑ line test ro rammed <br />sensor <br />Primary testing at: <br />E] <br />El positive shutdown Model: <br />ElPrima <br />si <br />El fail safe Serial #: <br />minutes <br />❑ NA <br />sensor <br />Secondary containment testing for: <br />❑ <br />❑ positive shutdown Model: <br />UDC(S) Piping <br />❑ fail safe Serial #: <br />Sump(s) UST(s) <br />❑ NA <br />Testing for the above components are next due by: <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />Note Please be aware that 2° containment components are required to be tested upon <br />El NA <br />installation, 6 months after, and every 36 months thereafter. <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Cold start of monitoring panel <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Corrosion protection <br />❑ <br />Overfill prevention (see LG letter 150-1) <br />❑ <br />Other: see below <br />❑x <br />This UST facility is APPROVED to operate <br />❑ <br />This UST facility is NOT APPROVED to operate <br />Witnessed secondary containment testing of the UDC under dispensers 1/2 using an Incon tester. <br />Passed. <br />Still need repairs and testing for satellite UDC 2/3. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Ins or: Receive y. Title: <br />CTt <br />EHD 23-04 Rev. 04/19/12 UST SERVICE REQUEST INSPECTION REPORT <br />