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oPa�ty••.o.c SAN JOAQUIN COUNTY <br /> � E� ma <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> �. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.slgov.org/ehd <br /> \C%Fp'R�i, <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> Cruisers Thursday, October 11, 2012 <br /> Facility Address: Service Request#: <br /> 1137 Lathrop Road, Manteca SR0065331 <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Exp.Date: Manufacturer Training: <br /> Gabriel Venegas 9/6/13 VR - 3/13/14 <br /> SERVICE SERVICE <br /> Leak detector <br /> El mechanical Model: Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector <br /> ❑ mechanical Model: Spill bucket ❑ minimum 5 gallon <br /> E3 ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> 87 VENT sensor <br /> El positive shutdown Model: 330020 -463 El Primary piping testing at: <br /> ❑fail safe Serial#: 17726 psi <br /> minutes <br /> ❑ NA <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 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% ❑ 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 /> ❑Q This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> erified functionality for the 87 vent smart sensor - passed. Positive shut down not required. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIM T EHD'S CURRENT HOURLY RATE. <br /> EHD Inspector: Received By: X Title: <br /> EHD 23-04 Rev.04/19/12 % UST SERVICE REQUEST INSPECTION REPORT <br />