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- .oti SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �• Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.siaov.orD/ehd <br /> r, <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> FedEx Wednesday, August 17, 2016 <br /> Facility Address: service Request#: <br /> 102 S. Hansen Road, Tracy, CA SR0072819 <br /> Onsite Service Technician's Name: ICC Service TechniciaNlnstaller 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: ❑ ❑ 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 Primary piping testing at: <br /> ❑ ❑positive shutdown Model: ❑ psi <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 W awarethat Ycontainment components are required to he tasted upon <br /> ❑ NA Installation,s months aneq and every 36 moms themaher. <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) 0 Other: see below <br /> ❑ This UST facility is APPROVED to operate 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 were tested and passed were the overfill and spill containers. All annulars were tested, <br /> however not all passed. EHD needs to come on site tomorrow to witness completion of the service <br /> request. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Ins ctm R y: Title: <br /> EHD 2&D4 Ra,.W19/12 UST SERVICE REQUEST INSPECTION REPORT <br />