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_?'�--�'t' •SAN JOAQUIN COUNTY <br />'9NVIRONMENTAL HEALTH DEPARTMENT <br />.. !, 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <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 />Quik Stop Market #7039 <br />12/16/2016 <br />Facility Address: <br />Service Request #: <br />2285 E. Fremont Street, Stockton, CA 95205 <br />SR0076329 <br />Onsite Service Technician's Name: <br />ICC Service Technician/Installer Exp. Data: <br />Manufacturer Training: <br />Juan Jauregui <br />19/21/2017 <br />Bravo 1/6/2019 Incon 3/10/2018 <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 />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ NA <br />sensor <br />❑ <br />❑ positive shutdown Model: <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 />0 This UST facility is APPROVED to operate <br />SER- ICE <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 />3/4 UDC(s) Piping <br />Sump(s) UST(s) <br />Testing for the above components are next due by: <br />June 2017 <br />Note: Please be aware that 21 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 />On site to witness two fifteen -minute Incon secondary containment testing of the 3/4 under dispenser <br />containment (UDC). The two Incon tests passed. Verified that potential dispenser piping leaks will <br />drain into UDC 3/4. Verified functionality of the 208 sensor in UDC 3/4. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. I <br />