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OAauln C <br /> � –+E�'•OG 0 <br /> SAN.IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> W, Il -, 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> A�%FO�� <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> Tracy Petro - Arco #2093 Friday, October 29, 2010 <br /> Facility Address: Service Request#: <br /> 3425 N. Tracy Blvd., Tracy SR0061218 <br /> Onsite Service Technician's Name: ICC Service Technician/Installer Exp.Date: Manufacturer Training: <br /> Joseph Serna 5/15/11 VR 4/27/11 <br /> SERVICE SERVICE <br /> Leak detector <br /> Spill bucket 13 minimum 5 gallon <br /> 13 mechanical Model: <br /> ❑ ❑ electronic Serial#: ❑ ❑1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test programmed <br /> 13 Caldwell System ❑Other <br /> Leak detector Spill bucket ❑minimum 5 gallon <br /> ❑mechanical Model: <br /> El <br /> 11 electronic Serial#: El 1 hour hydrostatic ❑Incon TS-STS <br /> 11 line test programmed <br /> 11 Caldwell System 11 Other <br /> Leak detector Spill bucket ❑minimum 5 gallon <br /> ❑mechanical Model: <br /> ❑ ❑electronic Serial#: ❑ ❑—1hour hydrostatic ❑Incon TS-STS <br /> ❑line test programmed <br /> 11 Caldwell System 11 Other <br /> 87 M-FILL sensor Prima piping testing at: <br /> ❑ <br /> X 0 positive shutdown Model: VR 749380-323 Primary❑x fail safe Serial#: 218544 ❑ psi <br /> p g g <br /> ❑NA minutes <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% ❑ Cold start of monitoring panel <br /> LODrop tube with mechanical overfill at 95% ElCorrosion protection <br /> Overfill prevention(see LG letter 150-1) ❑ Other: see below <br /> Verified functionality of 87 Master Fill sensor (1-6), including additional testing for fail safe, sensor out, <br /> and position sensitive shutdown. All passed. OK to operate facility. <br /> THIS FACILITY JECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EH D I ctor: R I d By: Title: <br /> EHD 23-04 UST SERVICE REQUEST INSPECTION REPORT <br /> Rev OC/ <br />