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4U1 N <br /> x°� .o� • SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ` 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:vuww.sioov.oro/ehd <br /> 9GiF o'RN; <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> Arch Arco AM PM Friday, January 27, 2012 <br /> Facility Address: service Request#: <br /> 4855 S. Hwy 99, Stockton SR0063958 <br /> Onsite Service Technician's Name: ICC Service Tec hniciaNlnstaller Exp.Date: Manufacturer Training: <br /> Lyle Nimmo �' 1 Tank tester y; , I'L 31 11 i'2- <br /> SERVICE <br /> 2SERVICE 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: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test pMrammed <br /> sensor Primary piping testing at: <br /> ❑ ❑ positive shutdown Model: 0 60 psi <br /> ❑fail safe Serial#: 30 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 ❑sensor Testing for the above components are next due by: <br /> El ❑ positive shutdown Model: <br /> ❑fail safe Serial#: Note Please be aware ,at P mntammem,components are mooned to be rested upon <br /> ❑ NA ins allation.6 months aver,and every%months Nemeher. <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) ❑ Other: see below <br /> ❑x This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> On site to witness primary line testing of the 87 and 89 product piping. Tested at 60 psg for 30 <br /> minutes. Passed. <br /> THIS FACILITY IS ECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspector. c Received y: Title: J <br /> lel' 0- o l^ i ✓ . <br /> UST SERVICE REQUEST INSPECTION REPORT <br /> EHD 2304 <br /> Rev 10/06/10 <br />