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O.P�u IN••.0 <br />). E� •.O <br />2:• _ �:Y ,Z AN JOAQUIN COUNTY <br />cr -+ ENVIRONMENTAL HEALTH DEPARTMENT <br />y. `, 600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd <br />•9G/FORD <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />Arco AM/PM (#82695) <br />Monday, May 2, 2011 <br />Facility Address: <br />Service Request #: <br />130 S. Wilson, Stockton <br />SR0062323 <br />Onsite Service Technician's Name: <br />CC Service Technician/Installer Exp. Date: <br />Manufacturer Training: <br />Carl Wayne Henderson <br />k252923UT7/28/2012 <br />VMI #2629 3/16/12; VR 6/14/11 <br />SERVICE <br />Leak detector <br />❑ <br />❑ mechanical Model: VR 848480-001 (w/Swiftcheck) <br />0 electronic Serial #: 314888 <br />O line test programmed <br />❑ <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />❑ <br />❑ line test programmed <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ NA <br />❑ <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ <br />❑ fail safe Serial #: <br />❑ <br />❑ NA <br />❑ <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 />0 This UST facility is APPROVED to operate <br />SERVICE <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 />❑ <br />Corrosion protection <br />❑ <br />Other: see below <br />❑ This UST facility is NOT APPROVED to operate <br />Observed new 87 -octane PLLD detected 3gph leak and alarm registered on the VR panel. <br />Submit a copy of updated UST Monitoring Plan to EHD within 30 days. <br />I THISFACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT_EHD'S CURRENT HOURLY RATE. <br />EHnDs e o �/j ] �, n I Received B I Title: / I <br />EHD 244 fG v UST SERVICE REQUEST INSPECTION REPORT <br />Rev 10/06/10 <br />