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O P"4 U.ih-C <br /> SAN JOAQUIN COUNTY <br /> a <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cP Telephone: (209)468-3420 Fax:(209)468-3433 Web:www.sigov.org/ehd <br /> 4</FOH� <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> FedEx Thursday, August 18, 2016 <br /> Facility Address: Service Request#: <br /> 102 S. Hansen Road, Tracy, CA SR0072819 <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Exp.Date: Manufacturer Training: <br /> Jarrod Cooke 4-19-17 VR, 5-9-18, VMI, 2-10-17 <br /> SERVICE SERVICE <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ 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 ❑ Incon TS-STS <br /> ❑ electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> sensor <br /> ❑ positive shutdown Model: ElPrimaps piping testing at: <br /> E] <br /> ❑fail safe Serial#: <br /> ❑ NA minutes <br /> sensor Secondary containment testing for: <br /> ❑ ❑ 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 /> El ❑ positive shutdown Model: <br /> ❑ fail safe Serial#: Note: Pleaae be aware that P containment cam <br /> pwents are required to be testes upon <br /> ❑ NA Installation,6 months atterane every 3fi monMs ihereatter. <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Cold start of monitoring panel <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Corrosion protection <br /> ❑ I Overfill prevention (see LG letter 150-1) 0 Other: see below <br /> ❑ This UST facility is APPROVED to operate 0 This UST facility is NOT APPROVED to operate <br /> On site to verify UST system is installed properly and functioning. The SR0072819 is incomplete. The <br /> items that still need to be tested/verified: <br /> - Leak detector <br /> - Vacuum Sensors <br /> - There is to much gravel in the Diesel 1 Fill Sump and Bio Diesel Piping Sump for lids to close and <br /> render water tight. <br /> EHD needs to come on site tomorrow to witness completion of the service request. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspector Rete' y: TitleC <br /> EHD 23-04 Rev.04/19/12 UST SERVICE REQUEST INSPECTION REPORT <br />