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2. c, SAN ..JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />/I 600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd <br />..oRa <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />SUPER CENTER MART <br />Tuesday, June 15, 2010 <br />Facility Address: <br />Service Request #: <br />701 E. CHARTER WAY, STOCKTON <br />SR0060174 <br />Onsite Service Technician's Name: <br />ICC Service Technician/Installer Exp. Date: <br />Manufacturer Training: <br />JOSEPH BARTHOLDI <br />06/23/10 04/09/11 <br />OPW= 08/12/10 <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 />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ <br />❑ electronic Serial #: <br />❑ line test programmed <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ <br />❑ NA <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑Q <br />❑ fail safe Serial #: <br />❑ <br />❑ NA <br />sensor <br />❑ <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 />SERVICE <br />91 Spill bucket ❑ minimum 5 gallon <br />Q <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System 0 Other <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 2° containment components are required to be tested upon <br />installation, 6 months after. and every 36 months thereafter. <br />❑ <br />Cold start of monitoring panel <br />❑Q <br />Corrosion protection <br />❑ <br />Other: see below <br />ONSITE TO VERIFY CORROSION PROTECTION OF REPLACED DIRECT BURY SPILL <br />CONTAINER FOR THE (91) PREMIUM UST. SPILL CONTAINER HAS BLACK TAPE AROUND <br />BASE OF RISER AND CAST IRON BOTTOM. FACTORY PROTECTIVE GUARD IS IN PLACE. OK <br />TO BACKFILL. OLD SPILL CONTAINER HAD A LOWER BAND THAT FAILED. SPILL <br />CONTAINER TEST IS SCHEDULED FOR TOMMORROW. <br />THIS ITY I CT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD c Rerei d By: / Title: r <br />/0 1� <br />EHD 23-04 <br />Rev 06/01/10 <br />UST SERVICE REQUEST INSPECTION REPORT <br />