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apou i N••.c <br /> SAN JOAQUIN COUNTY <br /> a: { ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> .• P Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.orq/ehd <br /> '9C%FpRia <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> Cruisers Tuesday.. December 20, 2011 <br /> Facility Address: Service Request*: <br /> 1137 Lathrop Road, Lathrop SR0063971 <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Exp.Date: Manufacturer Training: <br /> Jose Ochoa 18004551 - 1/13/12 VR - B35931, VMI - 10/3/13 <br /> SERVICE SERVICE <br /> Leak detector <br /> ❑ ❑ mechanical Model: Spill bucket ❑ minimum 5 gallon <br /> ❑ electronic Serial#: ❑ ❑ 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#: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test programmed ❑ Caldwell System ❑ Other <br /> 9/10uoc Dw sensor <br /> 0 El positive shutdown Model: VR 794380-304 Primary piping testing at: <br /> fail safe Serial#: 911799 ❑ psi <br /> ❑ NA minutes <br /> sensor Secondary containment testing for: <br /> ❑ positive shutdown Model: D ( ) Piping <br /> ❑ ❑ fail safe Serial#: Sump(s) <br /> ❑ NA UST(s) <br /> sensor ❑ Testing for the above components are next due by: <br /> ❑ ❑ positive shutdown Model: <br /> ❑fail safe Serial#: <br /> Note: Please be aware that 2°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% ❑x Cold start of monitoring panel <br /> ❑ Drop tube with mechanical overfill at 95% El Corrosion protection <br /> ❑ Overfill prevention (see LG letter 150-1) ❑ Other: see below <br /> Q This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> Verified functionality of the sensors after a point of sales (POS) upgrade - cold start. <br /> Tested all sensors - All passed except L 12 (disp 5/6 DW Brine sensor) was replaced and passed <br /> Tested all leak detectors and the overfill - all passed <br /> The diesel product line vacuum sensor lacked positive shut down fit was programed for positive shut <br /> down and verified. <br /> Small amount of liquid was found in all the sumps. The technician cleaned out all the liquid. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspector: Received By' Title: <br /> EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 10/06/10 <br />