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oP4u'tN`° SAN JOAQUIN COUNTY <br /> err ENVIRONMENTAL HEALTH DEPARTMENT <br /> ;. 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sggov.org/ehd <br /> C4��FORa`P <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> Boyett Petroleum/Valero Wednesday, February 9, 2011 <br /> Facility Address: Service Request M <br /> 1137 Lathrop Road, Manteca SR00 (-I�I`I <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Exp.Date: Manufacturer Training: <br /> Ruben Galindo PC,L '"1 I I - t;1r <br /> SERVICE SERVICE <br /> Leak detector <br /> ❑ mechanical Model: Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ ❑ 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 /> ❑ mechanical Model: <br /> E] ❑ electronic Serial#: El El hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test ro rammed El Caldwell System ❑ Other <br /> 91 Product sensor <br /> N positive shutdown Model: 0330020-496 Primary piping testing at: <br /> N fail safe Serial#: 10460002 ❑ psi <br /> ❑ NA minutes <br /> sensor Secondary containment testing for: <br /> ❑ positive shutdown Model: 0330020-496 UDC(s) Piping <br /> N fail safe Serial#: 10198 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 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) ❑ Other: see below <br /> ❑x This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> Witnessed functionality for S5 and S6 sensor. All passed. <br /> Verified positive shut down and fail safe - passed. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANYTIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspector: R Title: <br /> EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 10/06/10 <br />