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°P4utN ° SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N. 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax: (209)468-3433 Web:www.sipov.org/ehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> ABC Food Mart Tuesday, July 26, 2011 <br /> Facility Address: Service Request#: <br /> 713 N. EI Dorado, Stockton SR0062600 <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Exp.Date: Manufacturer Training: <br /> Gavim Williams 8016288-UT 8/6/2012 VR B33783(6/30/12); VMI 2013 <br /> SERVICE SERVICE <br /> Leak detector ql Spill bucket ❑ minimum 5 gallon <br /> ❑ mechanical Model:VR848480-001 (w/Swiftcheck) <br /> X❑ ❑x Z 1 hour hydrostatic ❑ Incon TS-STS <br /> 0 electronic Serial#: ❑ 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 /> 87 Annular sensor 303 <br /> ❑ positive shutdown Model: VR 7493804M El <br /> piping testing at: <br /> ❑ El❑ fail safe Serial#: �vltit! p 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 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"za_ <br /> ❑X This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> Observed existing diesel PLLD detected 3gph leak. Passed. <br /> Observed new 87-octane annular sensor test. Passed. <br /> Observed one-hour hydrostatic test of 87 and 91 spill buckets. Passed. Diesel spill bucket initially <br /> failed the hydrostatic test, but passed the retest after technicians cleaned out the drain. <br /> Technicians stated new gaskets for three manhole covers and spill buckets of the fill sumps have <br /> been installed to meet requirement of secondary containment tight against waster intrusion. <br /> THI§ FACILITY IS SUBJECT TO REINSPECTI AT ANY IM E 'S gqRRENT HOURLY RATE. <br /> EH=// Receive & h. Title: <br /> EH 23-04 Ir V UST SERVICE REQUEST INSPECTION REPORT <br /> Rev 10/06/1 <br />