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M aR4ury•c SAN JOAQUIN COUNTY <br /> �•.,art••.oG <br /> —SFr y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> > 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.sagov.org/ehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> Waterloo Liquors Friday, October 15, 2010 <br /> Facility Address: Service Request#: <br /> 2512 E. Waterloo Rd., Stockton SR0061062 <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Exp.Date: Manufacturer Training: <br /> Jesus Vera 15259508UT 5/5/2012 DPM Split Repair (1/21/2012) <br /> SERVICE SERVICE <br /> Leak detector <br /> Spill bucket D minimum 5 gallon <br /> D mechanical Model: <br /> ❑ ❑ ❑1 hour hydrostatic ❑Incon TS-STS <br /> ❑ electronic Serial#: ❑Caldwell System D Other <br /> ❑ line test programmed <br /> Leak detector Spill bucket ❑minimum 5 gallon <br /> ❑ ❑mechanical Model: ❑ ❑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 /> ❑ D mechanical Model: ❑ ❑1 hour hydrostatic ❑Incon TS-STS <br /> ❑electronic Serial#: D Caldwell System D Other <br /> ❑line test programmed <br /> sensor Primary piping testing at: <br /> D positive shutdown Model: <br /> ❑ O fail safe Serial#: ❑ psi <br /> ❑NA minutes <br /> sensor Secondary containment testing for: <br /> ❑ ❑positive shutdown Model: UDC(s) 87,91 Piping <br /> D fail safe Serial#: Sump(s) UST(s) <br /> ❑NA <br /> sensor 0 Testing for the above components are next due by: <br /> ❑ ❑positive shutdown Model: <br /> D fail safe Serial#: Note: Please be aware that 21 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 /> -- Two separate inspections were conducted at 9am and 11:30am. Observed secondary containment <br /> test of the 87 and 91-octane fuel piping at 5 psi post pouring of concrete at the north side of <br /> Dispenser#1/2 on 10/13/2010. The 91-octane test passed, but 87-octane test failed on two separate <br /> tests. SR0061062 permit condition has not been met. UST System not ready to return to operation. <br /> -- 87 and 91-octane UST product inventory were 4,787.28 and 1,277.09 during the first inspection, <br /> and 4702.43 and 1267.96 during the second inspection, respectively. Red Tag Significant Violation <br /> has not been corrected and the Red Tag remains affixed to the two UST fill pipings. <br /> THj§JACILITY IS SUBJECT TO REINSPECTION AT ANX TIME AT E 'S CURRENT HOURLY RATE. <br /> EHDMAQ,� Received By: Title: <br /> EHD 2 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 06/01/10 <br />