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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> a: a <br /> y' 600 East Main Street, Stockton, CA 95202-3029 <br /> I iP' Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.org/ehd <br /> 4(IFOkN\ <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> SRH Food & Gas Monday, December 13, 2010 <br /> Facility Address: Service Request#: <br /> 749 E. Charter Way, Stockton SR0061425 <br /> Onsite Service Technician's Name: ICC Service TechnicianAnstaller Exp.Date: Manufacturer Training: <br /> Carl Wayne Henderson 7/28/12 VR x. 6/14/11 <br /> SERVICE SERVICE <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: <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: El ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: <br /> ❑ line test programmed ❑ Caldwell System ❑ Other <br /> sensor <br /> E] ❑ positive shutdown Model: ❑ Primarypipingtesting at: <br /> ❑ fail safe Serial#: p <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 M Note l Please be aware that P wheinment mmponents are r"unedl to ba tested upon <br /> ❑ NA Installation.6 months after,and every 36 months thereafter <br /> ❑ Drop tube with mechanical overfill at 95% ❑x 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 /> ❑ This UST facility is APPROVED to operate 0 This UST facility is NOT APPROVED to operate <br /> Verified sensor functionality after cold start of monitoring panel. Passed. Unable to test 87 STP <br /> sensor- sump is covered by a stack of lumber. Facility is under construction and is not operational. <br /> Notice to Abate: <br /> 87 annular sensor went into alarm when tested, but would not come out of alarm. The interstitial <br /> space shall be monitored with a monitoring system connected to an audible and visual alarm system. <br /> Immediately contact a properly licensed, trained, and certified contractor to replace the failed <br /> component with a functional component (LG 113-x listed) under permit and inspection of the EHD <br /> within one business day. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Insp �q . R ived El_. Title: <br /> C� <br /> EH02304 't r9 vytaiI ed oco n v4 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 10/06/10 1. <br />