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a4�!ly. <br />?°L—•'�P 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 />ray/FOR�`� <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />Quik Stop Markets #39 <br />Monday, September 20, 2010 <br />Facility Address: <br />Service Request* <br />2285 E. Fremont, Stockton <br />SR0060875 <br />Onsite Service Technician's Name: <br />ICC Service Technician/Installer Exp. Date: <br />Manufacturer Training: <br />Brian Roth (Walton Engineering) <br />5093199 -UT (4/18/2011) <br />SERVICE <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />❑ line test programmed <br />❑ <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />❑ <br />❑ line test programmed <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ <br />❑ electronic Serial #: <br />❑ line test programmed <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />13 fail safe Serial #: <br />❑ <br />❑ NA <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ <br />❑fail safe Serial #: <br />❑ <br />❑ NA <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 />I Overfill prevention (see LG letter 150-1) <br />SERVICE <br />87 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 />O 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 atter, and every 36 months thereafter. <br />❑ <br />Cold start of monitoring panel <br />❑ <br />Corrosion protection <br />❑ <br />Other: see below <br />Observed 1 -hour hydrostatic test of the newly installed 87 octane fill sump OPW Model #511/521 spill <br />container. Passed. Deposition of petroleum fuel to this tank may resume. <br />*"Note: Conditions of the spill container replacement permit, SR0060875, required facility to cease <br />deposition of petroleum to the 87 octane tank (tank) until inspection of the spill container test and <br />approval by EHD. Inventory printout indicated fuel was deposited in the tank on 9/192010 at 11:58pm <br />to 9/20/2010 at 12:16am increasing from 5954 gallons recorded on 8/12/2010 to 7346 gallons. The <br />spill container was replaced on 8/13/2010 according to Walton technician and Walton invoice on site. <br />THP FACILITY IS SUB CT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD r._ /I Received By: �I ^� 6 Title: <br />EHD 215-04 VV / l I UST SERVICE REQUEST INSPECTION REPORT <br />Rev 06/01/10 v <br />