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P4u ry . <br /> SAN JOAQUIN COUNTY <br /> Q. ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> p. Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.siooy.ong/ehd <br /> 4GiFOFN� <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> Chevron #92033 Thursday, October 13, 2011 <br /> Facility Address: Service Request#: <br /> 508 W. Charter Way, Stockton pending <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Exp.Date: Manufacturer Training: <br /> Guadalupe Sanchez 4/23/13 VR x. 11/9/11 <br /> SERVICE SERVICE <br /> Leak detector <br /> ❑ mechanical Model: Spill bucket ❑ minimum 5 gallon <br /> ❑ <br /> ❑ electronic Serial#: <br /> El 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test programmed ❑ Caldwell System ❑ Other <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ mechanical Model: <br /> ❑ El ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: <br /> El line test programmed ❑ Caldwell System ❑ Other <br /> sensor <br /> ❑ positive shutdown Model: Primary piping testing at: <br /> ❑ ❑ fail safe Serial#: ❑ psi <br /> ❑ NA minutes <br /> sensor Secondary containment testing for: <br /> ❑ ❑ positive shutdown Model: UDC(s) Piping <br /> ❑fail safe Serial#: Sump(s) UST(s) <br /> ❑ NA <br /> sensor ❑ Testing for the above components are next due by: <br /> ❑ ❑ positive shutdown Model: <br /> ❑fail safe Serial#: Note Reale be aware that P wtainment mmponents are requireal to be tested upon <br /> ElNA bedallabon,6 months alter,and every W months thereafter. <br /> ❑ Drop tube with mechanical overfill at 95% Cold start of monitoring panel <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Corrosion protection <br /> ❑ Overfill prevention(see LG letter 150-1) ❑ Other: see below <br /> ❑x This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> A cold start of the monitoring panel was performed several times during the annual monitoring system <br /> certification due to a failure to reboot after fail safe testing. Verified system setup. The alarm history <br /> could not be printed prior to cold start, however, a printout was provided on the designated operator <br /> monthly inspection report dated October 10, 2011. Witnessed sensor functionality testing, including <br /> leak detectors (PLLDs). All passed. <br /> *'"Obtain a permit from the EHD for this work within one business day. If a permit is not obtained <br /> within one business day, a "Failure to Obtain a Permit" penalty will apply." <br /> THIS FACILI BJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Ins ct r: Re 1v / Title: / <br /> EHD 2304 — UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 10/06/10 <br />