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o.?'•a� I N••.c <br />SAN JOAQUIN COUNTY <br />_ cry G ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />• Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sogov.or /q ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />A -One Gas & Food <br />Monday, December 6, 2010 <br />Facility Address: <br />Service Request #: <br />574 W. Grant Line Rd., Tracy <br />SR0060720 <br />Onsite Service Technician's Name: <br />ICC Service Technicianlinstaller Exp. Date: <br />Manufacturer Training: <br />Herbert Pease / Ernie Bernabe <br />H.P. 12/4/12 E.B. 7/30/11 <br />E.B. Incon 5/26/11 <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 />0 <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 />❑x 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 />0 <br />50 psi <br />60 minutes <br />Secondary containment testing for: <br />1/2 3/4 5/6 7/8 UDC(s) 87 & 91 Piping <br />87 & 91 STP Sump(s) UST(s) <br />❑x <br />Testing for the above components are next due by: <br />06/06/2011 <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 />❑ This UST facility is NOT APPROVED to operate <br />Witnessed primary line testing at 50 psi for 60 minutes on 87 east primary line. Passed. Witnessed <br />secondary line testing at 5 psi for 60 minutes on 91 secondary piping failed. Passed. Witnessed <br />secondary containment lake test (Incon for 15 minutes) on all UDCs and sumps. Passed. <br />"Secondary containment testing for the newly installed piping will be required 6 months after the initial <br />testing (June 6, 2011). <br />Provided: Hazardous waste labels for drums of test water <br />THIS FACILITY IS SUBJECT TO REINSPECTIO T ANY TIME AT EHD'S CURRENT OURLY RATE. <br />EHD 42.- : 9 Received By: Title: ? f <br />EHD 23t'64 / UST SERVICE REQUEST INSPECTION REPORT <br />Rev 10/ <br />