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pQ. Vit• 1 N <br />SAN JOAQUIN COUNTY <br />C.' <br />2 2 ENVIRONMENTAL HEALTH DEPARTMENT <br />N: <br />bits 11868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />�Q Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />Valley Pacific Petroleum - Fresno Ave Cardlock <br />Thursday, June 7, 2012 <br />Facility Address: <br />Service Request #: <br />1524 Fresno Ave., Stockton <br />SR0064613 <br />Onsite Service Technician's Name:ICC <br />Service Technician/Installer Exp. Date: <br />Manufacturer Training: <br />Josh Simmons L19,120/13 <br />SERVICE <br />SERVICE <br />Leak detector <br />Spill bucket ❑minimum 5 gallon <br />❑ <br />El mechanical Model: <br />El❑electronic <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />Serial #: <br />[I Caldwell System L1 Other <br />El line test programmed <br />Leak detector <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ mechanical Model: <br />❑ <br />❑ 1 hour hydrostatic ❑Incon TS -STS <br />❑ electronic Serial #: <br />❑ Caldwell System ❑ Other <br />❑ line test programmed <br />sensor <br />P45ary piping testing at: <br />E] <br />❑ positive shutdown Model: <br />X <br />❑ <br />❑ fail safe Serial #: <br />psi <br />60 minutes <br />❑ NA <br />sensor <br />Secondary containment testing for: <br />❑ <br />❑ positive shutdown Model: <br />UDC(s) Satellite #1 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 20 containment components are required to be tested upon <br />❑ 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 />❑X <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 primary line testing of the piping to satellite #1 dispenser at 45 psi for 60 minutes. Passed. <br />Witnessed secondary containment testing of the piping to satellite #1 dispenser at 5.2 psi for 60 <br />minutes. Passed. Witnessed soil sampling under satellite #1 dispenser piping. Sample name: SP -1. <br />Dispensers #1/2 and 3/4 have not yet been removed for UDC repairs. This permit will remain open <br />until the visual inspection of the piping within the dispensers has been conducted after the dispenser <br />reinstallations. <br />I THIS FACILITYL5,SUBJECT TO REINSPECTIPX,AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD InspeAor Receiv By: Title: <br />EHD 23-04 Rev. 04TRS/12 UST SERVICE REQUEST INSPECTION REPORT <br />