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�Pqu I N•� <br /> SAN JOAQUIN COUNTY <br /> H. <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> � <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �•` Telephone: (209) 468-3420 Fax: (209) 468-3433 Web:www.sigov.org/ehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> Manteca Arco Thursday, May 2, 2013 <br /> Facility Address: Service Request#: <br /> 1711 E. Yosemite Ave., Manteca SR0066934 <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Exp.Date: Manufacturer Training: <br /> Sampler: Ray James <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 /> ❑ mechanical Model: <br /> ❑ ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial #: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> sensor <br /> ❑ positive shutdown Model: Elpsi <br /> testing at: <br /> E] <br /> ❑ fail safe Serial #: <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 21 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 /> ❑ This UST facility is APPROVED to operate ❑x This UST facility is NOT APPROVED to operate <br /> Witnessed soil sampling under previous locations of the under dispenser containment sumps (UDCs) <br /> and inside the piping trenches. Samples taken at 2 feet into native soil. Length of piping trench was <br /> 29 feet, including the portions in front of the dispensers. <br /> Additional inspections needed: <br /> - Sensor functionality - Secondary piping test <br /> - Leak detector test - 24 hour hydrostatic test of new UDCs <br /> - Spill bucket test - Verification of dispenser foot i t <br /> - Primary piping test - Visual inspection of pipin (thin dispensers <br /> THIS FACILITY IS SUBJECT TO REINSPECTI N Y TIME- -1=HD'S CURRENT HOURLY RATE. <br /> EHD Inspector: c d Title: <br /> EHD 23-04 /19/12 UST SERVICE REQUEST INSPECTION REPCRT <br />