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OP'•QuIN• <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N=. 600 East Main Street, Stockton, CA 95202-3029 <br /> CtgCiF'pRa`P <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 /> Cruisers # 29 Friday. July 22, 2011 <br /> Facility Address: Service Request : <br /> 1137 W Lathrop Road, Manteca SR0062544 <br /> Onsite Service Technician's Name: ICC Service Technician/installer Exp.Date: Manufacturer Training: <br /> Ceasar Rodriguz (s-p -IZ q 8028973UT - 1/13/12 VR - 10/20/11. VMI - 12/11 <br /> SERVICE SERVICE <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ mechanical Model: <br /> ❑ <br /> El electronic Serial#: E] ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> El line test programmed <br /> ❑ Caldwell System 11 Other <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ mechanical Model: <br /> E] <br /> El electronic Serial#: El 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test ro rammed El Caldwell System ❑ Other <br /> sensor <br /> [j El shutdown Model: E] Prima Peiping testing at: <br /> si <br /> ❑ fail safe Serial#: <br /> ❑ NA minutes <br /> 91DWsump(L3)sensor Secondary containment testing for: <br /> ❑ positive shutdown Model: 794380-304 UDC(s) Piping <br /> ❑fail safe Serial#: 853846 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 /> ❑ This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> 91 STP double wall sump sensor (1-3) was replaced and retested - Passed. <br /> Floats were put on the 87 ATG, Part #0886100-010 and Serial #1124P3117962. Verified 90% using <br /> tank chart - passed <br /> THIS FACILITY IS SUBJECT TO REINSPECTIO Y TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspector: Ived Title: <br /> EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 10/06/10 <br />