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Jun. 21 2008 2. 20PM ;`,West Star Environmental, Inc. No. 8243 P. 1 ffi <br /> "CM0CR M...s. <br /> ME <br /> Cafe: June 23,2008 <br /> M� .. _ �"°"° i' Requested By: Rhonda Robins <br /> ENTAL'` <br /> EN N INC. Tele one: 559-277-9378 x3010 <br /> SAL.KS- ucn0K-SERVICE -277-0106 <br /> 4®ft W. SIE 101.Fi o,Cx 93722 <br /> (S39)z7 370/ S59)277-0106 <br /> a <br /> INSPECTION REQUEST <br /> ................_.........................................._._.._..-------.._.._.----....«...................-........-.----r-....._.. r.........-.«...«..«..«..-.....«.-..----.-..............._............«........... ....� <br /> ,.«. •. _ <br /> `ac`tl eta'rs <br /> APCD Permit# sq� <br /> Facility Name: ESCALON MNI MART Contact Name: BILL <br /> Facility Address: 1097 E YOSEMITE Telephone: 1.209. <br /> City/State/Zip ESCALON, CA 95320 Fax: 1.209.838.1 <br /> Schedule Type.- <br /> Facility <br /> ype:Facility Start-up - Routine Compliance -. Cancellation «, . Reschedule X Retest <br /> ..............................................r...i......_._.......... ..._.._.._....«.....«....«...............«............_.._.------------'--_............................. <br /> Air Pollution Control Dist. Environmental Health Dept. <br /> Attention: Attention: AREA INSPECTOR <br /> Phone Number Phone Number: 1.209.468.3459 <br /> Fax Number: Fax Number: 1.209.468-3433 <br /> TestTime:1 -----------------, ---- 7.08.08 X1.30 PM---- <br /> ! ....� <br /> TP201.1 B-Static Torque ® Annual Monitoring <br /> TP201.1C/D-Drop Tube Spill Buckets Only <br /> ® TP 201.3 Leak Decay(ST30) SB989 <br /> v TP 201.36 Leak Decay(ST38) Mechanical Leak Detector Test <br /> _ TP201.4 Back Pressure(ST27) Pressure Line Test <br /> TP201.5 Air to Liquid Ratio(AIL) Cathodic Protector <br /> E <br /> � TP201.6C Liquid Removal ❑ Integrity Tightness <br /> Z <br /> z F-1V/L ® Designated Operator Inspection <br /> «. ® HIRT-Liqu ❑ <br /> id Removal(G-70-939) Primary Piping Inspection <br /> ® H I RT-Pressure Test(G-70-139) ® Secondary Piping Inspection <br /> Bag Test ® Temporary UST Closure inspection <br /> VR201 (Clean Air Separator) ® Helium Test <br /> Healy Fillneck Vapor Pressure ® Prev. Maint. <br /> Regulation (G-70-187) <br /> ® Healy Vapor Return Line Vacuum ❑ REPAIR <br /> Integrity(G-70-187) <br /> ® ISD Operability L <br /> Inspector acknowledgement Inspector acknowledgement <br /> Confirmation#: Confirmation#: <br /> Comments: PLEASE SIGN & RETURN <br /> Tester Information <br /> ®Customer Acknowledgement ❑On Account Trav/Mi <br /> ®APCD Acknowledgement ❑COD *6 Permit <br /> ®EHD Acknowledgement F-1 Contract Rates Fee to Obain <br />