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SAN JOAQUIN COUNTY <br /> 'c ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Web:www.sogov.org/ehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> J & L Market Monday, May 19, 2014 <br /> Facility Address: Service Request#: <br /> 8115 S. EI Dorado St., Stockton SR0069389 <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Exp.Date: Manufacturer Training: <br /> Felix Ramirez 12/6/14 VR x. 6/25/14 <br /> SERVICE SERVICE <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 /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> El mechanical Model: <br /> ❑ ElEl1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: ❑ Caldwell System ElOther <br /> El line test programmed <br /> sensor <br /> ❑ ❑ positive shutdown Model: Primary Elpsi <br /> testing at: <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 be aware that 2°containment components are required to be tested upon <br /> ❑ NA installation,6 months after,and every 36 months thereafter. <br /> ❑ Drop tube with mechanical overfill at 95% Q 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 /> Witnessed sensor functionality verification testing after a cold start of the monitoring panel (conducted <br /> April 3, 2014), including fail safe and sensor out. All passed. <br /> THIS FACILITY 15-SUBJECT TO REINSP TI AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> L (ReEHD Insp or: <br /> iv y: Title: <br /> EHD 23-04 Rev.0 UST SERVICE REQUEST INSPECTION REPORT <br />