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0.p4u tN\ 16 <br /> /,v/��•� • SAN JOAQUIN COUNTY <br /> la: - '�1 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ` 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> hugll <br /> . <br /> <`. Telephone:(209)468-3420 Fax:(209)468-3433 Web:wwwsigov.org/ehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> Charter Way Chevron Friday, January 17, 2014 <br /> Facility Address: Service Request#: <br /> 508 W. Dr. Martin Luther King, Jr. Blvd., Stockton SR0068457 <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Exp.Date: Manufacturer Training: <br /> Joe Bartholdi 7/12/12 <br /> SERVICE SERVICE <br /> Leak detector 87-octane Spill bucket ❑ minimum 5 gallon <br /> N ❑ mechanical Model: ❑x ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑electronic Serial#: ❑ Caldwell System O Other <br /> ❑ line test programmed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> N ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> sensor Primary piping testing at: <br /> ❑ ❑ positive shutdown Model: ❑ psi <br /> ❑ fail safe Serial#: minutes <br /> ❑ NA <br /> sensor Secondary containment testing for: <br /> N ❑ positive shutdown Model: UDC(s) Piping <br /> ❑fail safe Serial#: Sump(s) UST(s) <br /> ❑ NA Elsensor Testing for the above components are next due by: <br /> ❑ ❑ positive shutdown Model: <br /> ❑failsafe Serial#: Note Please be aware that 2°containment components are required to be tested upon <br /> ❑ NA installation,b months attar and every 3E monMs thereafter. <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Cold start of monitoring panel <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Corrosion protection <br /> ❑ Overfill prevention (see LG letter 150-1) Other: see below <br /> NX This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> Visual inspection of the piping under dispensers 1/2 and 7/8. No leaking observed. Verified drainage <br /> on the new 87 (old diesel) spill container. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Ins r: Received By: � Title:u' <br /> EHD 23-0 R 4/19/12 UST SERVICE REQUEST INSPECTION REPORT <br />