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oPqul"•:\ <br /> SAN JOAQUIN COUNTY <br /> c. al ENVIRONMENTAL HEALTH DEPARTMENT <br /> �y 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)468-3433 Web:www.sjgov.org/ehd <br /> ��/PORN <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> Valley Service Station Monday, February 4, 2013 <br /> Facility Address: Service Request#: <br /> 16 E. Harding, Stockton SR0066355 <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Exp. Date: Manufacturer Training: <br /> Joe Batholdi 7/12/13 see below <br /> SERVICE SERVICE <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> El mechanical Model: <br /> ❑ ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial #: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ mechanical Model: <br /> ❑ ❑ ❑ 1 hour hydrostatic D Incon TS-STS <br /> ❑ electronic Serial #: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> sensor <br /> ❑ El shutdown Model: Elpsi <br /> testing at: <br /> ❑ fail safe Serial #: minutes <br /> ❑ NA <br /> sensor Secondary containment testing for: <br /> ❑ ❑ positive shutdown Model: UDC(s) Piping <br /> ❑ fail safe Serial #: Sump(s) UST(s) <br /> ❑ NA <br /> sensor ❑ Testing for the above components are next due by: <br /> ❑ ❑ positive shutdown Model: <br /> ❑ fail safe Serial#: Note Please be aware that 21 containment components are required to be tested upon <br /> ❑ NA installation,6 months after,and every 36 months thereafter. <br /> ❑ Drop tube with mechanical overfill at 95% ❑Q Cold start of monitoring panel <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Corrosion protection <br /> ❑ Overfill prevention (see LG letter 150-1) ED Other: see below <br /> ❑Q This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> Observed functionality of the monitoring system tested, and it passed. <br /> Technician on site did not have verification of his current Veeder Root and CPT manufacturer's <br /> training. Technician stated cerification of manufacturer's training will be emailed/submitted to EHD <br /> within one business day. Please be aware if the certification turned out to be invalid, this monitoring <br /> system certification today may be rejected by EHD. <br /> T S ACILITY IS SUBJECT TO REINSPECTION TIME AT EHD'S CURRENT HOURLY RATE. <br /> EH Inspe Rece Title: <br /> EHD 23-04 Rev. 4/19/12 UST SERVICE REQUEST INSPECTION REPCRT <br />