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�gq-VA b. <br /> SAN JOAQUIN COUNTY <br /> r ENVIRONMENTAL HEALTH DEPARTMENT <br /> l <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Web:www.sigov.org/ehd <br /> ra..4 <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> 99 Shell (Angle Petroleum) May 10, 2017 <br /> Facility Address: Service Request#: <br /> 7700 Moreland Street, Stockton, CA 95212 SR0075676 <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Exp.Date: Manufacturer Training: <br /> Dreg Kaiser 110/26/2017 % 4/11/2019 3ravo 5/13/18, VR 9/12/18 <br /> SERVICE SERVICE <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ mechanical Model: <br /> ❑ ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: <br /> ❑ line test ro rammed ❑ Caldwell System ❑ Other <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ mechanical Model: <br /> ❑ ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> DSL FILL sensor <br /> ❑ positive shutdown Model: 794380-304 L12 Primary piping testing at: <br /> E] psi <br /> ❑ fail safe Serial#: not legible <br /> minutes <br /> 9 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) 0 Other: see below <br /> ❑x This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> On site to verify functionality of the recently installed diesel fill sump annular space liquid sensor <br /> 794380-304 (1-12). Verified the integrity of the 87-product STP sump after installation of the Bravo <br /> fiberglass split retrofit SD-AB fittings inside and outside of the 87-product sump wall at electrical <br /> penetrations, it passed the one-hour test at 10 inches of mercury. Verified annular space <br /> communication in UDC-5-6. Verified annular space communication in the 87-, 91- and diesel-product <br /> STP and fill sumps; Verified vacuum sensor monitoring of the secondary containment �,in of the <br /> S1:87 line, S2:vapor line, S3:91 line, S4:87-91 vent line, S5: diesel line, and S6: these in All 1 <br /> passed. 5)l�) t <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT NY TI AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspect ` Received Title <br /> G L <br /> EHD 23-04 Rev.04/19/12 UST SERVICE REQUEST INSPECTION REPORT <br />