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Oct. 31, 2006 5:34PM Wegt Star Environmental, Inc, No. 0824 P. 1/1 <br /> 0 <br /> Data:October 3,2005 <br /> E STA t Requested By. Monica ndo <br /> __11N R_P ENTALtNC. Telephone: 559-277-9378 x3010 <br /> SALES• TRUtrzoN-SERMiCE Fax 559-277-0106 <br /> W. SM 191.F669Ro.C�13722 <br /> (669) Seo/ )277-0196 <br /> INSPECTION REQUEST <br /> Facility Details <br /> APCD Permit 0 <br /> Facility Name- Facalon Mini Mart Contact Name: Bill _ <br /> Facility Address: 1097 E.Yosemite Telephone: 209-838-1546 <br /> City/Statef ip Escalon.CA 95320 Fax: 209-838-1546 '— <br /> Schedule Type: <br /> Facility Start-up X s Routine Compliance .m,,.! Cancellation Reschedule ( Retest <br /> - W_ <br /> Air Polution Control Dist. Environmental Health Dept. <br /> Attention: Attention: Toua Yan <br /> Phone Number: _ Phone Number: (209)48$3459 <br /> Fax Number: Fax Number: 09 4W3433 <br /> iTest Time: Test Time: November lQ 2005 N <br /> ` ❑ TP201.1 B-Static Torque I ! ® Annual Monitoring <br /> ❑ TP201.9 C!D-Drop Tube ❑ Spill Buckets Only <br /> L3JklSED <br /> TP 201.3 Leak Decay(ST30) i ;` SB989 i <br /> ❑ TP 201.38 Leak Decay(ST38) I ❑ Mechanical Leak Detector Test t <br /> „� ❑ TP201.3C Pipe Connections Test ❑ Pressure Line Test <br /> ® TP201.4 Back Pressure(ST27) j ❑ Cathotic Protector <br /> E TP201.5 Air to Liquid Ratio j ® Integrity Tightness <br /> ❑ TP201,6C Liquid Removal <br /> © Designated Operator Inspection <br /> ® VR901B ❑ Primary Piping inspection <br /> ❑ Secondary Piping Inspe(xlon <br /> Inspector acknowledgement: ® Temporary UST Inspection <br /> 9 _ _ Inspector ack��a=�nt: <br /> ConVmation #:Varbal Per Toua Yank <br /> Comments: Please write the t=acit Ipft and confin"ation ft on your results! <br /> Tester Information <br /> ®Customer Acknowledgement ❑On Account <br /> ravlMi <br /> ❑APCDAcknowledgement ®COD Permit <br /> ❑EHD Acknowledgement ❑Contract Rates Fee to Obain <br /> FWDI <br />