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RQU I(y <br />SAN JOAQUIN COUNTY 10 <br />-V '{ ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fan: (209) 468-3433 Web: www.sjgov.org/ehd <br />L/i=ORa <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />Chevron USA <br />Friday, February 3, 2012 <br />Facility Address: <br />Service Request #: <br />1960 W. 11th St. Tracy, CA 95376 <br />SR0064016 <br />Onsite Service Technician's Name: <br />ICC Service Technician/Installer Exp. Date: <br />Manufacturer Training: <br />Tim Coulter <br />19-1-12 <br />VR 9-2-12, FF 8-2-12 <br />SERVICE <br />SERVICE <br />Leak detector <br />91 -octane Spill bucket O minimum 5 gallon <br />❑ <br />❑ mechanical Model: <br />� <br />D 1 hour hydrostatic ❑Incon TS -STS <br />❑ electronic Serial #: <br />D Caldwell System 21 Other <br />❑ line test programmed <br />Leak detector <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ mechanical Model: <br />❑ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />❑ electronic Serial #: <br />❑ Caldwell System ❑ Other <br />❑ line test programmed <br />sensor <br />Primaps piping testing at: <br />E] <br />❑ positive shutdown Model: <br />❑ <br />❑ fail safe Serial #: <br />minutes <br />❑ NA <br />sensor <br />Secondary containment testing for: <br />❑ <br />❑ positive shutdown Model: <br />UDC(s) Piping <br />❑ fail safe Serial #: <br />Sump(s) UST(s) <br />❑ NA <br />❑ <br />Testing for the above components are next due by: <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />Note: Please be aware that 21 containment components are required to be tested upon <br />D NA <br />installation, 6 months after, and every 36 months thereafter. <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Cold start of monitoring panel <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Corrosion protection <br />❑ <br />Overfill prevention (see LG letter 150-1) <br />❑ <br />Other: see below <br />This UST facility is APPROVED to operate <br />❑ <br />This UST facility is NOT APPROVED to operate <br />On site to witness the 91 spill container integrity vacuum test at - 30hli one minute. It Passed. <br />v cUiOMI-4 <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inspector: _ceiv--- Title: <br />EHD 23-04 UJ 1 JCKvIl.t mrwuro I INOr•cli 1 IUN mar -UR 1 <br />Rev 10/06/10 <br />