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°g4�1K•0 <br />� —+F�' •P� SAN JOAQUIN COUNTY <br />z� ENVIRONMENTAL HEALTH DEPARTMENT <br />..:. 600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjoov.org/ehd <br />0 <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />Valley Pacific Petroleum Services <br />Friday, February 4, 2011 <br />Facility Address: <br />Service Request #: <br />1501 W. Charter Way, Stockton <br />SR0061713 <br />Onsite Service Technician's Name: <br />ICC Service Technicianlinstaller Exp. Date: <br />Manufacturer Training: <br />Frederick Babel <br />17/7/12 <br />VR x. 7/30/12 <br />SERVICE <br />SERVICE <br />Leak detector <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />❑ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />❑ line test programmed <br />❑ Caldwell System ❑ Other <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 r rammed <br />E] <br />sensor <br />❑ positive shutdown Model: <br />E3Primary <br />S piping testing at: <br />❑ fail safe Serial #: <br />minutes <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 atter, and every 36 months thereafter. <br />❑ <br />Drop tube with mechanical overfill at 95% <br />Cold start of monitoring panel <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Corrosion protection <br />❑ <br />Overfill prevention (see LG letter 150-1) <br />❑ <br />Other: see below <br />© <br />This UST facility is APPROVED to operate <br />❑ <br />This UST facility is NOT APPROVED to operate <br />Witnessed sensor functionality, sensor out, and fail safe after cold start of monitoring panel. All <br />passed. Verified panel setup. CPU will not be replaced. <br />THIS FACILITY UBJECT TO REINSPE TION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inspe or: R ved By:, Title: <br />EHD 23-04/ "� v UST SERVICE REQUEST INSPECTION REPORT <br />Rev 10/06/1 <br />