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OO9QU 1,N,,.0 <br />Inspection Date: <br />A -One Gas & Food <br />SAN JOAQUIN COUNTY <br />-� <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />�q<% <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd <br />F O'1'RN`P <br />Service Technician/Installer Exp. Date: <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />A -One Gas & Food <br />Friday, December 3, 2010 <br />Facility Address: <br />Service Request #: <br />574 W. Grant Line Rd., Tracy <br />SR0060720 <br />Onsite Service Technician's Name:ICC <br />Service Technician/Installer Exp. Date: <br />Manufacturer Training: <br />Herbert Pease <br />12/5/10 <br />1 Western Fiberglass x. 8/30/12 <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 />❑x <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 LG 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 />❑x <br />50 psi <br />60 minutes <br />Secondary containment testing for: <br />UDC(s) 87 & 91 Piping <br />Sump(s) UST(s) <br />Testing for the above components are next due by: <br />06/03/2011 <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 />❑ <br />Other: see below <br />❑X This UST facility is NOT APPROVED to operate <br />Witnessed piping soap test. Passed. Witnessed primary line testing at 50 psi for 60 minutes. 87 east <br />primary line failed. 87 west and both 91 primary lines passed. Witnessed secondary line testing at 5 <br />psi for 60 minutes. 91 secondary piping failed. 87 secondary piping passed. <br />Retest needed for 87 east primary line and 91 secondary piping. Secondary containment testing for <br />UDCs and STP sumps still needed. <br />I THIS FACILITY IS -SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. I <br />EHD Insp r: Received Byz, 7 Title: <br />EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br />Rev 10/06/1 <br />