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quiN <br />� ••�'•.o�SAN .10AQUiN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd <br />�IspR <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name; <br />Chevron <br />Facility Address: <br />1442 Colony Road, Ripon <br />Onsite Service Technician's Name: ICC Service Techniciai <br />Joey Mesa ICC# 5259458 5 <br />SERVICE <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />❑ line test programmed <br />❑ <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />❑ <br />❑ line test programmed <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ NA <br />❑ <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑X <br />❑ fail safe Serial #: <br />❑ <br />❑ NA <br />❑ <br />sensor <br />El❑ <br />positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ NA <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Overfill prevention (see LG letter 150-1) <br />RX This UST facility is APPROVED to operate <br />Inspection Date: <br />Thursday, February 2, 2012 <br />Service Request #: <br />SR0064231 <br />installer Exp. Date: Manufacturer Training: <br />,/13 VR - A27796 1113112 <br />SERVICE <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System ❑ Other <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System ❑ Other <br />Primary piping testing at: <br />❑ <br />psi <br />minutes <br />Secondary containment testing for: <br />UDC(s) Piping <br />Sump(s) UST(s) <br />❑ <br />Testing for the above components are next due by: <br />Note: Please be aware that 21 containment components are required to be tested upon <br />installation, 6 months after, and every 36 months thereafter. <br />❑X <br />Cold start of monitoring panel <br />❑ <br />Corrosion protection <br />❑ <br />Other: see below <br />❑ This UST facility is NOT APPROVED to operate <br />Service Station Systems authorized Tanknology to perform the cold start (1 /23/12) during the <br />monitoring certification performed today. <br />All sensors passed, verified positive shut down and fail safe, also verified overfill @ 90% and PLLD. <br />All passed. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />(\j1+10- <br />Received By: <br />EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br />Rev 10/06110 <br />