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op4�1�1. <br /> SAN.JOAQUIN COUNTY <br /> 2: <br /> W_ <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> rt• _ cp <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.s*gov.org/ehd <br /> �i�dRN <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> WATERLOO FOODMART Monday, May 13, 2013 <br /> Facility Address: Service Request#: <br /> 4315 WATERLOO RD, STOCKTON, CA SR0066989 <br /> Onsite Service Technician's Name: ICC Service Technician/installer Exp.Date: Manufacturer Training: <br /> Jarod Burke Installer-10/10/14 Bravo Double Wall-10-16-14 <br /> SERVICE SERVICE <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ mechanical Model: <br /> ❑ El 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: [I Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> El mechanical Model: <br /> ❑ ❑ ❑ 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: El -psi <br /> C1 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 21 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% ❑ Cold start of monitoring panel <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Corrosion protection <br /> ❑ Overfill prevention (see LG letter 150-1) Q Other: see below <br /> Q This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> f& 5 <br /> On-site to verify restoration of monitoring to 87 STP turbine sump and 87 secondary containment lines <br /> after product pipe and penetration fittings repair. Observed new penetration fittings after installation; <br /> electrical and product line penetrations were replaced. Could not observe the installation of BRAVO <br /> interstitial fluid into sump's interstitial space because the top BRAVO port appeared to be blocked, <br /> according to the service technician. The service technician will obtain a statement from the <br /> manufacturer authorizing the new barb fitting installation and will obtain an approved repair kit to be <br /> utilized during the install. The contractor must amend the existing permit. The station is authorized to <br /> sell fuel for two days while the repairs are taking place. Verified that interstitial monitoring for vapor <br /> and fuel was restored to 87 lines and 87 STP sump (continued on page 2). <br /> THIS FACILITY IS SUBJECT TO REINSPECT AT AN E AT EHJMCURRENT HOURLY RATE. <br /> EHD Insp r: % I FKc_eivedj�/ Title: <br /> EHD 23-04 ev.04/19/12 UST SERVICE REQUEST INSPECTION REPORT <br />