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?°,L.rF� SAN JOAQUIN COUNTY <br />c �{ ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />Valley Pacific Fresno Ave. Cardlock <br />`4 2011-1 <br />Facility Address: <br />Service Request #: <br />1524 Fresno Ave., Stockton <br />SR0069128 <br />Onsite Service Technician's Name:ICC <br />Service Technician/Installer Exp. Date: <br />Manufacturer Training: <br />Josh Simmons <br />10/7/15 <br />1 VR x. 5/12/15 <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 programmed <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ NA <br />❑X <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 />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 />1/2 & 3/4 UDC(s) Diesel (all) Piping <br />Diesel STP Sump(s) Diesel UST(s) <br />❑X <br />Testing for the above components are next due by: <br />9/14 (UDCs, STP sump, new piping) <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 />0 <br />Other: see below <br />0 This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br />*Witnessed sensor functionality testing of all sensors. The UDC 3/4 sensor was not functioning and <br />had to be replaced at the time of inspection - see Onsite Retrofit Verification report. All passed. <br />*Witnessed secondary containment testing of UDC 1/2, UDC 3/4, and the diesel STP sump. All <br />passed. <br />*Witnessed secondary containment testing of the tank annular space - 10 in. Hg for 60 minutes. <br />Passed. <br />*Witnessed secondary containment testing of all piping lines - 5 psi for 60 minutes. All passed. <br />*Verified dispenser footprint and piping within the dispensers is all contained by new UDCs. <br />THIS FACILITY IS BJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inspector: Received By: Titley���� <br />EHD 23-04 Rev. 04/19/12 UST SERVICE REQUEST INSPECTION REPORT <br />