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I <br /> p?+4V I�•• <br /> >• +E�'•a� SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.sigov.org/ehd <br /> �4�iFoa��7 <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> Waterloo Food & Fuel Tuesday, July 13, 2010 <br /> Facility Address: Service Request* <br /> 3032 E. Waterloo, Stockton SR0060381 <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Exp.Date: Manufacturer Training: <br /> Guadalupe Sanchez 15250451-UT (4/30/2011) OPW No. P 4810 (1/14/11) <br /> SERVICE SERVICE <br /> Leak detector 91 91 minimum 5 gallon <br /> ❑ mechanical Model: Spill bucket <br /> ❑ ❑ electronic Serial#: 0 O 1 hour hydrostatic ❑Incon TS-STS <br /> ❑Caldwell System ❑Other <br /> ❑ line test programmed <br /> Leak detector Spill bucket ❑minimum 5 gallon <br /> ❑ ❑mechanical Model: ❑ ❑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 /> ❑ 13❑electronic Serial#: ❑ 1 hour hydrostatic ❑Incon TS-STS <br /> 13 line test programmed <br /> 13 Caldwell System ❑Other <br /> sensor Primary piping testing at: <br /> ❑positive shutdown Model: psi <br /> ❑ <br /> 13 fail safe Serial#: ❑ minutes <br /> ❑NA <br /> sensor Secondary containment testing for: <br /> ❑ ❑positive shutdown Model: UDC(s) Piping <br /> 13 fail safe Serial#: Sump(s)91 octane 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 r 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) ❑ Other: see below <br /> Observed technician conducted 1-hour hydrostatic test on the spill bucket of the 91 octane UST. <br /> Passed. Also observed secondary containment test conducted on the 91 octane UST.Technician <br /> induced 10 inches of Hg vacuum pressure in the 91 octane UST annular space for 30 minutes. The <br /> vacuum pressure remained unchanged after 30 minutes, and no soap bubbles were observed. <br /> Passed secondary containment testing of the tank. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD`S CURRENT HOURLY RATE. <br /> EHI Redd By: TMe:I <br /> EHD 2 W UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 06/01/10 <br />