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a��t' IK•• c <br />SAN JOAQUIN COUNTY <br />'x ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sjgov.org/ehd <br />���rFOiR�`r <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />Waterloo Liquors <br />Wednesday, October 13, 2010 <br />Facility Address: <br />Service Request: <br />2512 E. Waterloo Rd., Stockton <br />SR0061062 <br />Onsite Service Technician's Name: <br />IGC Service Technician/Instalter Exp. Date: <br />Manufacturer Training: <br />Jesus Vera <br />15259508UT 5/5/2012 <br />DPM Split Repair (1/21/2012) <br />SERVICE <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />❑ line testprogrammed <br />❑ <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />❑ <br />❑ line test programmed <br />Leak detedor <br />❑ <br />❑ mechanical Model: <br />❑ <br />electronic Serial #: <br />❑ line test pLogEarnmed <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />® <br />❑ NA <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ <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 />Drop tube with mechanical overfill at 95% <br />r❑ <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 />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) 87 Piping <br />Sump(s) UST(s) <br />® <br />Testing for the above components are next due by: <br />04/13/2011 <br />Note: Please be aware that 21 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 />--Observed concrete poured in the excavation at the north side of Dispenser #1/2. Split boot repair <br />was conducted on the 87and 91 -octane fuel lines in the UDC of Dispenser #1/2 and #3/4. <br />--Observed secondary containment test of the 87 -octane fuel piping at 5 psi maintained for one hour, <br />and two consecutive 15 -minute hydrostatic tests (equivalent to 24 hour) on UDC at Dispenser #1/2 <br />using Incon. Passed. Test of the replaced components is required six months after installation. <br />-- Secondary containment test of 87 and 91 -octane fuel line after concrete is poured and set for at <br />least 24 hours is required. UST System not ready to return to operation. <br />1 THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD 230+/ ll / / / UST SERVICE REQUEST INSPECTION REPORT <br />Rev 06/01/14 <br />