Laserfiche WebLink
NCL V 1.1y <br /> 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.s*- ov.org/ehd <br /> CR��FOR�`P <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> Arco AM PM #5450 Friday, November 4, 2011 <br /> Facility Address: Service Request : <br /> 1617 W. Fremont St., Stockton SR0063611 <br /> Onsite Service Technician's Name: ICC Service Technicianlinstaller Exp.Date: Manufacturer Training: <br /> Chris Bishop 15/14/12 VR x. 6/8/12 <br /> SERVICE SERVICE <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ mechanical Model: <br /> ❑ ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: ❑ Caldwell System ❑Other <br /> ❑ line test programmed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ mechanical Model: <br /> ❑ ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: ❑Caldwell System ❑ Other <br /> ❑ line test programmed <br /> 91 FILL sensor <br /> 91 positive shutdown Model: 794380-344 Primary piping testing at: <br /> El psi <br /> p fail safe Serial#: 879189 <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 20 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 /> ❑X This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> Witnessed sensor verification testing of 91 fill sump sensor, including fail safe and sensor out. <br /> Passed. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT NY TIME T EHD'S CURRENT HOURLY RATE. <br /> EHD Inspector: Received By: Title: <br /> L'l c <br /> EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 10/06/10 <br />