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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.sigov.org/ehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> 7-Eleven #17334 11/22/2016 <br /> Facility Address: Service Request#: <br /> 4501 N. Pershing Avenue, Stockton, CA SR0076156 <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Exp.Date: Manufacturer Training: <br /> Bryan Mitchell 6/11/2018 Veeder Root 8/18/2018 <br /> SERVICE SERVICE <br /> Leak detector <br /> ❑ mechanical Model: Spill bucket ❑ minimum 5 gallon <br /> ❑ <br /> ❑ electronic Serial#: 1:1 ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test programmed ❑ Caldwell System ❑ Other <br /> Leak detector <br /> ❑ mechanical Model: Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ electronic Serial#: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test programmed ❑ Caldwell System ❑ Other <br /> Veeder Roct sensor <br /> ® ❑x positive shutdown Model: 794380-208 Primary piping testing at: <br /> ❑ fail safe Serial#: ❑ psi <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 <br /> sensor ❑ Testing for the above components are next due by: <br /> ❑ ❑ positive shutdown Model: <br /> ❑ fail safe Serial#: Nate Please be aware that P containment components are mammal to be tested upon <br /> ❑ NA instalietron,6 months after,and eery W monNs 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 /> On site to verify functionality of the 87-product and 91-product submersible turbine pump (STP) sump <br /> Veeder Root 0794380-208 newly-installed sensors. The serial number for the 87-product 208 sensor <br /> is 1197286 and the serial number for the 91-product 208 sensor is 1187978. Note: the 87-product <br /> 794380-352 sensor was lying down in the sump at arrival. This 352 sensor was replaced by the <br /> installation of the 208 sensor positioned vertically in the sump. This was corrected on site. <br /> Witnessed positive shut down for both sensors. Passed. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT END'S CURRENT HOURLY RATE. <br /> EHD lnspector7_ Re ved By. Title: <br /> �N <br />