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SAN JOAQUIN COUNTY <br /> - ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> P . Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> Lakewood Chevron Tuesday, August 21, 2012 <br /> Facility Address: Service Request#: <br /> 236 N. Ham Ln., Lodi SR0065393 <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Exp.Date: Manufacturer Training: <br /> Joe Bartholdi 7/12/14 VR x. 1/17/13 VMI x. 8/1/14 <br /> SERVICE SERVICE <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> 0 mechanical Model:Red Jacket FX1DV p <br /> ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> 11 electronic Serial#: <br /> El tine test programmed ❑ 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 /> sensor <br /> E] ❑ positive shutdown Model: E] psi piping testing at: <br /> ❑fail safe Serial#: p <br /> ❑ NA minutes <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 20 containment components are required to be tested upon <br /> ❑ NA installation,6 months atter,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) ❑X Other: see below <br /> O This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> Witnessed 3 gph at 10 psi testing of the diesel mechanical leak detector. Passed. Verified positive <br /> shutdown of diesel turbine, after replacement of the diesel relay, by dipping the diesel sensor in fuel. <br /> Passed. During fail safe testing the diesel turbine went into positive shutdown, however, the <br /> monitoring panel got stuck in a warm start and would not come back up. A cold start was performed <br /> on the monitoring panel at the time of inspection. Witnessed functionality verification of the sensors, <br /> including fail safe and sensor out, at the time of inspection. Passed. <br /> **An updated scope of work must be submitted for the additional repairs completed under this permit. <br /> THIS FACILITY SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> E I pector. Receiv Titl <br /> EHD 2&04 19/12 UST SERVICE REQUEST INSPECTION REPORT <br />