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R• nth• <br />0 41 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />mom I1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.s*gov.org/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />COS Municipal Service Ctr. <br />Thursday, January 3, 2013 <br />Facility Address: <br />Service Request #: <br />1465 S. Lincoln St., Stockton <br />SR0065598 <br />Onsite Service Technician's Name: <br />ICC Service Technician/Installer Exp. Date: <br />Manufacturer Training: <br />Charles Ferrucci <br />112/14/14 <br />1 Incon x.12/29/13 <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 />El <br />❑ line test programmed <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ NA <br />sensor <br />❑ <br />❑ positive shutdown Model: <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 />0 This UST facility is APPROVED to operate <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 />Primary <br />El <br />minutes <br />Secondary containment testing for: <br />5/6 and 7/8 UDC(s) Piping <br />Sump(s) UST(s) <br />Testing for the above components are next due by: <br />07/03/2013 <br />Note: Please be aware that 20 containment components are required to be tested upon <br />installation, 6 months after, and every 36 months thereafter. <br />❑ <br />Cold start of monitoring panel <br />❑ <br />Corrosion protection <br />❑ <br />Other: see below <br />❑ This UST facility is NOT APPROVED to operate <br />Witnessed secondary containment testing of UDCs 5/6 and 7/8 with an Incon tester. Both passed. <br />Witnessed secondary containment testing of the diesel east product piping - 3 psi for 60 minutes. <br />Passed. <br />I THIS FACILITY IS SUBJECT TO REINSPECTION AT.ANYX4M AT END'S CURRENT HOURLY RATE. I <br />EHD Inspector: <br />EHD 23-04 Rev. -44/19/12 UST SERVICE REQUEST INSPECTION REPORT <br />