Laserfiche WebLink
QAct�!? <br /> ?'�� SAN JOAQUIN COUNTY <br /> 4' I ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Web:www.si-ov.or /q ehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> ARP Mini Mart Corporation May 26, 2016 <br /> Facility Address: Service Request#: <br /> 25775 South Patterson Pass Road, Tracy, CA SR0074743 <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Exp.Date: Manufacturer Training: <br /> Michael Kennard Elite IV1001331 11/4/16 10/15/17 Phil-Tite 11/18/17 <br /> SERVICE SERVICE <br /> Leak detector 87-siphon Spill bucket EI minimum 5 gallon <br /> ❑ mechanical Model: <br /> ❑ <br /> El electronic Serial#: L9 El 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test ro rammed El Caldwell System ❑ Other <br /> Leak detector 87-slave Spill bucket Z minimum 5 gallon <br /> El mechanical Model: <br /> ❑ <br /> E3 electronic Serial#: ❑X F11 hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test programmed <br /> El Caldwell System El Other <br /> sensor <br /> ❑ positive shutdown Model: ElPrima Peiping testing at: <br /> si <br /> ❑ fail safe Serial#: <br /> [I 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. Please be aware that 21 containment components are required to be tested upon <br /> ❑ NA installation,6 months after,and every 36 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 /> On site to witness one-hour hydrostatic testing of the 87-product siphon and 87-product slave fill spill <br /> containers for newly installed Phil-Tite model 85100-1 buckets. Each spill container held greater than <br /> five gallons of water and both spill containers passed the one-hour hydrostatic test. This facility is <br /> approved to operate. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspector: / l✓ <br /> Received By: 7 Title: <br /> ✓ <br /> I a t L/ 3L <br /> . D , t i.✓ <br /> EHD 23-04 Rev.04/19/12 UST SERVICE REQUEST INSPECTION REPORT <br />