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oq�utM ° SAN JOAQUIN COUNTY <br />c —Y` ENVIRONMENTAL HEALTH DEPARTMENT <br />y` 600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sipov.org/ehd <br />'9GlFOR� <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Wilson Way Chevron <br />Inspection Date: <br />Tuesday, February 15, 2011 <br />Facility Address: <br />Service Request #: <br />437 N. Wilson Way, Stockton <br />TBA <br />Onsite Service Technician's Name: <br />ICC Service Technician/installer Exp. Date: <br />Manufacturer Training: <br />Guadalupe Sanchez <br />�5250451UT / 4/30/2011 <br />VMI /32008 5/22/2011 <br />SERVICE <br />Leak detector <br />X <br />❑ <br />0 mechanical Model: VMI 99 LD -2000 <br />❑ electronic Serial #: 10071107 <br />❑ line test programmed <br />❑ <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />❑ <br />IFI line test programmed <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ NA <br />❑ <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ <br />❑ fail safe Serial #: <br />❑ <br />❑ NA <br />❑ <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ 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 />N This UST facility is APPROVED to operate <br />SERVICE <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System ❑ Other <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />❑ 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 />❑ <br />Corrosion protection <br />❑ <br />Other: see below <br />❑ This UST facility is NOT APPROVED to operate <br />Witnessed referenced replaced line leak detector for 87 -octane detected a leak at 3gph at 10psi. <br />Reliable Contractor License A is 883706, exp 7/3/2011. This work was done on emergency repair <br />basis. Obtain a permit from the EHD for this work within one business day. If a permit is not obtained <br />within one business day, a "Failure to Obtain a Permit" penalty will apply. <br />I THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. I <br />Received By: <br />Title: <br />EHD 23-(x4 / V / J UST SERVICE REQUEST INSPECTION REPORT <br />Rev 10/06/10 ( / <br />