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yiy <br /> >.`�.• , SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> \cp Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.or-q/ehd <br /> "Fo4" <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Dale: <br /> Chevron #92033 10/23/2015 <br /> Facility Address: Service Request is <br /> 508 w Dr. Martin Luther King Jr. Blvd. SR0072757 <br /> Onsite Service Technician's Name: ICC Service Technicianllnstaller Exp.Date: Manufacturer Training: <br /> Fredrick Babel 02/20/2017 <br /> SERVICE SERVICE <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> sensor Primary piping testing at: <br /> ❑ ❑ positive shutdown Model: ❑ psi <br /> ❑fail safe Serial#: minutes <br /> ❑ NA <br /> sensor Secondary containment testing for: <br /> ❑ <br /> El 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 /> El <br /> ❑fail safe Serial#: Note Please be aware that 2°madonmentoomponents are required to be tested upon <br /> ❑ NA Instenatioa 6 months after,and every 36 months thereafter. <br /> ❑x 87A 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 /> On site for the inspection of the 87A flapper that was installed in July 23, 2015 and verification of the <br /> measurements. The service technician calculated the 95 percent mark for the flapper to be 63.25 <br /> inches. The flapper was measured at 64 inches. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspe ar: r Received B Title: <br /> t <br /> EHD 23-04 Rev. 12 UST SERVICE REQUEST INSPECTION REPORT <br />