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>°A4— -t'�o� SAN JOAQUIN COUNTY <br /> 2 r ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)468-3433 Web:www.s*qov.org/ehd <br /> ��f.F ORN <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> TenSpace 4/6/2016 <br /> Facility Address: Service Request#: <br /> 800 E. Main Street SR0073144 <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Exp.Date: Manufacturer Training: <br /> SERVICE SERVICE <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> El mechanical Model: <br /> ❑ ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> El mechanical Model: <br /> E, El ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> sensor <br /> F, ❑ positive shutdown Model: ❑ Primary testing at: <br /> si <br /> ❑ fail safe Serial #: 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 21 containment components are required to be tested upon <br /> ❑ NA Iinstallation,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) El Other: see below <br /> ❑ This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> On site to witness soil sampling underneath piping at every twenty linear feet and stockpile. Two soil <br /> samples-one sample underneath the piping and the second sample was the stockpile-were taken. The <br /> samples were labeled as "Line east 2 ft" and "Stockpile #3." The piping has not been taken off site yet <br /> and will be taken as hazardous waste. The service company, AGE, is in process of obtaining a <br /> temporary EPA ID for the generator, Tenspace, to haul of the piping. The area of the open excavation <br /> is located on the property of Tenspace and is fenced off and blocked with caution tape while pending <br /> analysis. Once lab results for the soil samples are released, please have the lab send the results to <br /> Garrett Backus at gbackus@sjcehd.com and his contact phone number is 209-468-2986. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspector: ` Received 1By: Title: <br /> EHD 23-04 Rev.04/19/12 UST SERVICE REQUEST INSPECTION REPORT <br />