Laserfiche WebLink
opggtuI.N, C•'' <br />?'-+E'F''•P SAN JOAQUIN COUNTY • <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />{ <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />Quik Stop Markets Inc # 125 <br />Friday, June 17, 2011 <br />Facility Address: <br />Service Request #: <br />1580 W Main St Ripon <br />SR0062766 <br />Onsite Service Technician's Name: <br />ICC Service Technician/Installer Exp. Date: <br />Manufacturer Training: <br />Gerardo Guzman JR <br />5242481 8/1/11 <br />OPW 12/29/11 <br />SERVICE <br />SERVICE <br />Leak detector <br />87 Spill bucket minimum 5 gallon <br />❑ <br />11 mechanical Model: <br />❑Caldwell <br />c 0 Incon TS -STS <br />❑electronic Serial #: <br />System ❑ Other <br />❑ line test programmed <br />Leak detector <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ mechanical Model: <br />❑ <br />❑ —1hour hydrostatic ❑ Incon TS -STS <br />❑ electronic Serial #: <br />❑ Caldwell System ❑ 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 />❑ positive shutdown Model: <br />El <br />Primary piping testing at: <br />❑ <br />❑ fail safe Serial #: <br />psi <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 2' containment components are required to be tested upon <br />❑ 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 LIS letter 150-1) <br />❑ <br />Other: see below <br />Witnessed testing of 87 spillbucket using caldwel <br />OK to operate <br />�1 W A U/" —1 9 <br />THIS FACILITY IS SUBJECT TO REINSP€CTI[GINVAT ANY TIME�H QCURRENT HOURLY RATE. <br />RHD 2304 / / UST SERVICE REQUEST INSPECTION REPORT <br />Rev 06/01/10 <br />