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vo PgU�N...C� <br /> ¢..' �!. 'Oz SAN JOAQUIN COUNTY <br /> lei 's <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> r ¢ Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigoy.orq/ehd <br /> 9(i.gi5g <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> Arch Arco AM PM Tuesday, July 3, 2012 <br /> Facility Address: Service Request#: <br /> 4855 S. Hwy 99, Stockton SR0065010 <br /> Onsite Service Technician's Name: ICC Service TachnictaNlnstaller Exp.Date: Manufacturer Training: <br /> Guadalupe Sanchez 4/23/13 VR x. 11/8/13 <br /> SERVICE SERVICE <br /> Leak detector <br /> ❑ ❑ mechanical Model: Spill bucket ❑ minimum 5 gallon <br /> ❑ electronic Serial#: El 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test programmed ❑ Caldwell System ❑ Other <br /> Leak detector <br /> ❑ ❑ mechanical Model- Spill bucket ❑ minimum 5 gallon <br /> ❑ electronic Serial#: El 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test programmed ❑ Caldwell System ❑ Other <br /> a7 FILL sensor <br /> ❑ positive shutdown Model: VR 794380-344 Primary piping testing at: <br /> ❑fall safe Serial#: 879250 ❑ _psi <br /> ❑ NA _minutes <br /> sensor Secondary containment testing for: <br /> ❑ ❑ positive shutdown Model: UDC s <br /> ❑fail safe Serial#: ( ) Piping <br /> ❑ NA Sump(s) UST(s) <br /> sensor ❑ Testing for the above Components are next due by: <br /> ❑ ❑ positive shutdown Model: <br /> ❑fail safe Serial#: <br /> ❑ NA Note: Please be anare that Y mmainmem mmponents are mWired to be tested upon <br /> installatim,breadths after,and every36 montos 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 /> This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> Witnessed verification testing of the 87 master fill sensor. Passed. <br /> THIS FACILITY IS OBJECT TO REINSPECTION AT ANYTIME AT E D'S CURRENT HOURLY RATE. <br /> EHD Inspe or: Received Title: / <br /> EHD 23-04 Rev. 19/12 UST SERVICE REQUEST INSPECTION REPORT <br />