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SAN JOAQUIN COUNTY <br />c ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <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 />Arco #5450 <br />Tuesday, September 16, 2014 <br />Facility Address: <br />Service Request #: <br />1617 W. Fremont St., Stockton <br />SR0070299 <br />Onsite Service Technician's Name: <br />ICC Service Technician/Installer Exp. Date: <br />Manufacturer Training: <br />Elodio Sanchez <br />19/10/15 <br />1 VMI x. 9/17/14 VR x. 7/23/16 <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 />❑ <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑x <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 />SERVICE <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 />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 after, and every 36 months thereafter. <br />❑x <br />Cold start of monitoring panel <br />❑ <br />Corrosion protection <br />❑ <br />Other: see below <br />❑X This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br />Witnessed verification testing of the sensors, ATGs, and leak detectors after a second cold start of the <br />monitoring panel, including fail safe and sensor out. All passed. <br />**A cold start of the monitoring panel was performed Friday, September 12, 2014 after the inspection <br />was conducted. An updated scope of work needs to be submitted to include this additional cold start. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY T4ME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inspect ReceivedByf ,�` Title: <br />_� , <br />�4 <br />EHD 23-04 Rev. 04/19/12 ` UST SERVICE REQUEST INSPECTION REPORI <br />