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oP��IN• c <br /> ? '•04 SAN JOAQUIN COUNTY <br /> N ru { ENVIRONMENTAL HEALTH DEPARTMENT <br /> '. 600 East Main Street, Stockton, CA 95202-3029 <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 /> Bank of Stockton Monday, January 24, 2011 <br /> Facility Address: Service Request S: <br /> 1941 Lockheed Ct, SWtockton SR0061676 <br /> Onsite Service Technician's Name: ICC Service TechnicianAnstaller Exp.Date: Manufacturer Training: <br /> Jared Burke 19/9/11 <br /> SERVICE SERVICE <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: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> sensor Primary piping testing at: <br /> ❑ ❑ positive shutdown Model: 47 psi <br /> ❑fail safe Serial#: 60 minutes <br /> ❑ NA <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 2°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 LIS letter 150-1) ❑ Other: see below <br /> FX1 This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> Witnessed 1 hour test on the primary piping pressurised at 47 psi. A bubble was found on the <br /> checked valve. The leak was repaired and retested. All passed. <br /> THIS FACILITY IS SUBJECT TO REI NSPECTI T ANY TIM A HD'S CURRENT HOURLY RATE. <br /> EHD Inspector: Re By: > <br /> EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 10/06/10 <br />