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eg5!ly, <br /> SAN JOAQUIN COUNTY . -° 17 <br /> .r Z{ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.s' ov.or / <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name. - Inspection Date: <br /> SJC Public Works Corp. Yard Wednesday, January 19, 2011 <br /> Facility Address: Service Request#: <br /> 1810 E. Hazelton Ave, Stockton SR0060840 <br /> Onsite Service Technician's Name: ICC Service Technicianlinstaller Exp.Date: Manufacturer Training: <br /> Benjamin Duncan 15246802-UT 4/11/2011 Cadwell <br /> SERVICE SERVICE <br /> Leak detector Spill bucket D minimum 5 gallon <br /> D mechanical Model: <br /> ❑ ❑ D 1 hour hydrostatic O Incon TS-STS <br /> electronic Serial#: p Caldwell System 0 Other <br /> p line test programmed <br /> Leak detector Spill bucket I]minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ 0 1 hour hydrostatic D Incon TS-STS <br /> O electronic Serial#: Q Caldwell System 0 Other <br /> D line test programmed <br /> sensor <br /> E3 positive shutdown Model: Primary piping testing at: <br /> ❑ p fail safe Serial#: 11 psi <br /> C) NA minutes <br /> sensor Secondary containment testing for: <br /> ❑ p positive shutdown Model: UDC(s) 87/Diesel Piping <br /> 0 fail safe Serial#: 87/Diesel STP Sump(s) UST(s) <br /> NA <br /> sensor 0 Testing for the above components are next due by: <br /> ❑ 0 positive shutdown Model: <br /> ❑fail safe Serial#: Note: Please be aware that 2°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) ❑ Other:see below <br /> ❑ This UST facility is APPROVED to operate ® This UST facility is NOT APPROVED to operate <br /> - Observed secondary containment test on 87-octane and diesel fuel line. Pressure was induced to <br /> 5.3 psi. for the 87-octane, and 5.1 psi. on the diesel line for 1 hour. Passed. <br /> - Observed 1-hour equivalent hydrostatic test using Cadwell system on the 87-octane and diesel STP <br /> sumps. Passed. <br /> - Secondary containment test on the diesel UST post set-up of the concrete pad is not required since <br /> the annual space of the UST is brine filled. <br /> Conditions of the permit SR0060840, and retest of the failed components of the tri-annual secondary <br /> containmer)t testing on April 2, 2010, have been met. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANX TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD In or: V V Red By: Title: <br /> --• <br /> EHD A4 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 10/06/10 <br />