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0 0 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> c � <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> c. P Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.siclov.org/ehd <br /> 9licUE�� <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> Valley Pacific Petroleum Services, Inc. #1004 Wednesday, March 23, 2011 <br /> Facility Address: Service Request#: <br /> 3550 S. Hwy 99, Stockton TBA <br /> Onsite Service Technician's Name: ICC Service Technicianlinstaller Exp.Date: Manufacturer Training: <br /> Michael Lawrence (Tank-Tek) 11 048103-UT (5/12/2011) VR LvA A26642 12/2/2011 <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: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> sensorModel: VR 794390-420 Primary piping testing at: <br /> ❑ positive shutdown <br /> ❑fail safe Serial#: 759924 ❑ mpsi <br /> inutes <br /> ❑ NA <br /> sensor Secondary containment testing for: <br /> ❑ If 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 be aware that 20 containment components are required to be tested upon <br /> ❑ NA Installation.6 orders after.and every 36 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) ❑ Other: see below <br /> ❑X This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> Observed functionality test of the replaced annular sensor for the Diesel/87-octane split tank; passed. <br /> The new annular sensor was replaced as an emergency repair. Submit permit application and <br /> appropriate fee to EHD within one business day. <br /> THIS FACILITY ISPUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHsp t Re eived By: Title: <br /> L4 L42�2�— <br /> EH 3-04 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 10106110 <br />