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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.sjgov.org/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />Wilson Way Chevron <br />Thursday, February 16, 2012 <br />Facility Address: <br />Service Request #: <br />437 N. Wilson, Stockton <br />(TBA) <br />Onsite Service Technician's Name: <br />ICC Service Technician/installer Exp. Date: <br />Manufacturer Training: <br />Guadalupe Sanchez <br />15250451 UT 4/30/2011 <br />VR A30138 11/8/2013 <br />SERVICE <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />0 line test programmed <br />❑ <br />Leak detector <br />❑ <br />0 mechanical Model: <br />El electronic Serial #: <br />❑ <br />❑ line test programmed <br />67 F4PING sensor <br />® <br />0 positive shutdown Model: VR 794380-208 <br />0 fail safe Serial #: 918224 <br />0 NA <br />❑ <br />sensor <br />❑ <br />0 positive shutdown Model: <br />❑ <br />❑ fail safe Serial #: <br />Ej NA <br />H❑ <br />❑ <br />sensor <br />❑ <br />0 positive shutdown Model: <br />p fail safe Serial #: <br />p NA <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Overfill prevention (see LG letter 150-1) <br />0 This UST facility is APPROVED to operate <br />SERVICE <br />Spill bucket O minimum 5 gallon <br />❑ <br />O 1 hour hydrostatic O Incon TS -STS <br />O Caldwell System 0 Other <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />p 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System ❑ Other <br />Primary piping testing at: <br />❑ <br />psi <br />minutes <br />Secondary containment testing for: <br />UDC(s) Piping <br />Sump(s) UST(s) <br />❑ <br />Testing for the above components are next due by: <br />Note: Please be aware that 2° containment components are required to be tested upon <br />installation, 6 months after, and every 36 months thereafter. <br />❑ <br />Cold start of monitoring panel <br />Corrosion protection <br />H❑ <br />❑ <br />Other: see below <br />(I This UST facility is NOT APPROVED to operate <br />Observed newly installed 87 -octane STP 208 sensor. Passed. <br />/) THIS AUATY IS SUOJEr i TO REINSPECTION AT ANY TIM9 gT EHD'S CURRENT HOURLY RATE. <br />EHD I,r] ector r . j' j /� `� Received By: -� Title-� �' € <br />EI -1643-04 A / /� / / UST SERVICE REQUEST INSPECTION REPORT <br />Rev 10/06/10 (� <br />