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• qG.0!!y. � � � <br /> SAN JOAQUIN COUNTY <br /> to .,X ENVIRONMENTAL HEALTH DEPARTMENT <br /> F. 600 East Main Street,Stockton,CA 95202-3029 <br /> 9cIKa. �: <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: Inspection Date: <br /> Arco AM PM #5450 Wednesday, February 9, 2011 <br /> Facility Address: Service Request : <br /> 1617 W. Fremont St., Stockton SR0061818 <br /> Onsite Service Technician's Name: ICC Service TechniciaNlnstaller Exp.Date: Manufacturer Training: <br /> Christopher Bishop 5/14/12 VR x. 6/8/12 <br /> SERVICE SERVICE <br /> Leak detector <br /> ❑ 11 mechanical Model: Spill bucket ❑minimum 5 gallon <br /> El electronic Serial#: El 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test programmed ❑ Caldwell System ❑Other <br /> Leak detector <br /> ❑ ❑ mechanical Model: Spill bucket ❑minimum 5 gallon <br /> 11electronic Serial#: El 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑line test programmed ❑Caldwell System ❑Other <br /> sensor <br /> © 91 positive shutdown Model: VR 749380-323 Primary piping testing at: <br /> O fail safe Serial#: 234259 ❑ psi <br /> ❑ NA minutes <br /> sensor Secondary containment testing for: <br /> ❑ ❑positive shutdown Model: UDC(s) Piping <br /> ❑fail safe Serial#: Sump(s) UST(s) <br /> ❑ NA <br /> sensor ❑ Testing for the above components are next due by: <br /> ❑ ❑ positive shutdown Model: <br /> ❑fail safe Serial#: Note: Please be aware that 2°containment components are required to be tested upon <br /> ❑ NA installation,6 months after,and every 36 months thereafter. <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Cold start of monitoring panel <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Corrosion protection <br /> ❑ Overfill prevention(see LG letter 150-1) ❑ Other:see below <br /> N This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> The position indicator was not functioning on the newly replaced sensor at the time of inspection. A <br /> new sensor was installed by the technician on site. Verified sensor functionality, sensor out, and fail <br /> safe. Passed. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AVA.Ny TIME AT END'S CURRENT HOURLY RATE. <br /> EHD Inspector_ � Received � � T' � �� . <br /> r :V A <br /> EHD04 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 10/ <br />