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�' •?� SAN JOAQUIN COUNTY <br />r = ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sogov.org/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />Waterloo Liquor <br />Wednesday, October 13, 2010 <br />Facility Address: <br />Service Request is <br />2512 E. Waterloo <br />SR0057217 <br />Onsite Service Technician's Name: <br />ICC Service Technician/Installer Exp. Date: <br />Manufacturer Training: <br />Jesse Vera <br />15259508UT 5/5/2012 <br />Franklin 357353761 11/25/10 <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 ffo rammed <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />Cl <br />❑ electronic Serial #: <br />❑ line test programmed <br />sensor <br />E]13positive <br />shutdown Model: <br />13 fail safe Serial #: <br />❑ NA <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ <br />❑fail safe Serial #: <br />❑ <br />❑ NA <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 />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System ❑ Other <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />0] 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 />Cl <br />psi <br />minutes <br />Secondary containment testing for: <br />UDC(s) 91 Piping <br />Sump(s) UST(s) <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 />❑ <br />Cold start of monitoring panel <br />❑ <br />Corrosion protection <br />❑ <br />Other: see below <br />Observed secondary containment testing of the 87 -octane fuel piping at 5 psi maintained for one <br />hour. Passed. I <br />Previous inspection on October 11, 2010 verified secondary containment test of 91 -octane and diesel <br />fuel lines passed. Conditions of SR0057217 have been met. <br />UST System not ready to return to operation until the conditions of separate permit SR0061062 have <br />been met. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inspector. Received By: Title: <br />EHD 23-04 74 <br />UST SERVICE REQUEST INSPECTION REPORT <br />Rev 06/01/10 <br />