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OPgl11N C • SAN JOAQUIN COUNTY <br /> .—�.r. .y ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> .. ca Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.org/ehd <br /> ��IFOR� <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;r: <br /> 4855 S. Hwy 99, Stockton SR0063959 <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Exp.Date: Manufacturer Training: <br /> Joe Bartholdi 7/7/12 CPT 12/9/13 <br /> SERVICE SERVICE <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ mechanical Model:After CPT rewiring <br /> � ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> O electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ mechanical Mode: <br /> ❑ l ❑ ❑ 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 neat due by: <br /> ❑ ❑ positive shutdown Model: <br /> ❑fail safe Serial#: Note Please be aware that r wnta nment wra onenis are repuirea to be WMd upon <br /> ❑ NA installation,6 mons after,and every W months 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) ❑x 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 functionality testing of the 87 CPT (PLLD). Tested at 10 psi at 3 gph. Initial testing <br /> resulted in the leak detector resetting and attempting to find a leak repeatedly. The tester was <br /> recalibrated for a higher leak rate (closer to 3 gph). The leak detector was retested and passed. <br /> Verified positive shutdown of the 87 STP. <br /> THIS FACILITY IS SU CT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspector: Received By: Title: <br /> f rr 'r✓ <br /> EHD 23-04 j UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 10/06110 C <br />