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"a <br />Q��1.; .��'y, ` (saris+ .,. ,� . - ,•. i�u <br />SAN JOAQUIN COUNTY <br />MAR 6 � 201 / <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />i 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />f Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.si /eh¢,oNMEIV I AL HEALTH <br />k -M <br />FCR%' NVIR <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSA; ION R�tPORT <br />Facility Name: <br />Inspection Date: <br />Pilot Travel Center, LLC <br />12/16/2016 <br />Facility Address: <br />Service Request #: <br />1501 North Jack Tone Road, Ripon, CA 95366 <br />SR0076380 <br />Onsite Service Technician's Name: <br />ICC Service TechniciaMnstaller Exp. Date: <br />Manufacturer Training: <br />James Blaine <br />7/14/2018 <br />Incon 9/29/2018 <br />SERVICE <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />❑ line test programmed <br />❑ <br />Leak detector <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />❑ <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 LIS letter 150-1) <br />❑ 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 />❑ <br />psi <br />minutes <br />Secondary containment testing for: <br />' UDC(s) Piping <br />T5 -91/T6 -die Sump(s) UST(s) <br />Testing for the above components are next due by: <br />June 2017 <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 />0 This UST facility is NOT APPROVED to operate <br />On site to witness secondary containment testing of the T-5 premium unleaded submersible turbine <br />pump (STP) sump and the T-6 diesel (auto side) STP sump. The T-6 diesel STP sump passed the <br />fifteen -minute Incon test. The T-5 premium unleaded STP sump did not pass the fifteen -minute Incon <br />test and is not approved to operate. Reschedule testing of the T-5 premium unleaded STP sump once <br />repairs have been made. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. j <br />EHD Inspgctor. �1 I Received BYA n . _ Title:. <br />