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n <br />.1 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 JAN 2016 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd <br />ENVIRONMENTAL <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPEMON WpOWENT <br />Facility Name: Inspection Date: <br />Escalon Naini mart Wednesday, January 27, 2016 <br />Facility Address: Service Request 9: <br />1097 E. Yosemite Ave., Escalon SR0074051 <br />Onsite Service Technician's Name:ICC Service Technicianlinstaller Exp. Date: Manufacturer Training: <br />Jose Ochoa 11/12/18Incon 2/10/17 <br />SERVICE <br />SERVICE <br />Leak detector <br />❑ ❑ mechanical Model: <br />❑ electronic Serial #: <br />❑ line test programmed <br />❑ Caldwell System ❑ Other <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />® 1 hour hydrostatic ❑ Incon TS -STS <br />❑ electronic Serial #: <br />❑ Caldwell System ❑ Other <br />❑ line test programmed <br />Primary <br />Primary piping testing at: <br />91 STP sensor <br />® <br />0 positive shutdown Model Incon <br />minutes <br />❑ fail safe Serial #: TSP-ULS <br />Secondary containment testing for: <br />❑ NA <br />UDC(s) Piping <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />Testing for the above components are next due by: <br />❑ fail safe Serial : <br />Note: Please be aware that 2° containment components are required to be tested upon <br />installation, 6 months after, and every 36 months thereafter. <br />❑ NA <br />Cold start of monitoring panel <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />Other: see below <br />❑ fail safe Serial #: <br />❑ NA <br />❑ <br />Drop tube with mechanical overfill at 95%6 <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Overfill prevention (see LG letter 150-1) <br />® This UST facility is APPROVED to operate <br />❑ This UST facility is NOT APPROVED to operate <br />#n site to witness testing of sensor functionality for 91 STP sensor, one hour testing of 87 and 91 sp-41 <br />buckets and verify minimum of 5 -gallon capacity and proper drainage. All passed. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT A Y TIME AT END'S CURRENT HOURLY RATE. <br />EHD Inspector: (y ,VA I ` 0 Received By: s Title: <br />EHD 23-04 Rev. 04/19/12 UST SERVICE REQUEST INSPECTION REPORT <br />87 Spill bucket El minimum 5 gallon <br />N <br />El 1 hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System ❑ Other <br />97 Spill bucket ® minimum 5 gallon <br />® <br />® 1 hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System ❑ Other <br />Primary <br />Primary piping testing at: <br />El <br />minutes <br />Secondary containment testing for: <br />UDC(s) Piping <br />Sump(s) UST(s) <br />❑ <br />Testing for the above components are next due by: <br />Note: Please be aware that 2° containment components are required to be tested upon <br />installation, 6 months after, and every 36 months thereafter. <br />❑ <br />Cold start of monitoring panel <br />❑ <br />Corrosion protection <br />❑ <br />Other: see below <br />❑ This UST facility is NOT APPROVED to operate <br />#n site to witness testing of sensor functionality for 91 STP sensor, one hour testing of 87 and 91 sp-41 <br />buckets and verify minimum of 5 -gallon capacity and proper drainage. All passed. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT A Y TIME AT END'S CURRENT HOURLY RATE. <br />EHD Inspector: (y ,VA I ` 0 Received By: s Title: <br />EHD 23-04 Rev. 04/19/12 UST SERVICE REQUEST INSPECTION REPORT <br />