Laserfiche WebLink
°t¢autlY SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.ora/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />Nella - Olympian #427 <br />Friday, December 10, 2010 <br />Facility Address: <br />Service Request #: <br />3300 Waterloo Road, Stockton <br />SR0061572 <br />Onsite Service Technician's Name: <br />ICC Service Technicianiinstaller Exp. Date: <br />Manufacturer Training: <br />Ryan Powell <br />15257345UT 5/16/2011 <br />VR LA4 B33011 6/23/2011 <br />SERVICE <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />❑ line test programmed <br />❑ <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />❑ <br />❑ line test programmed <br />DSL FILL sensor <br />® <br />❑ positive shutdown Model: VR 794390-420 <br />❑ fail safe Serial #: 851161 <br />❑ NA <br />® <br />87 FILL sensor <br />® <br />❑ positive shutdown Model: VR 794390-420 <br />❑ <br />❑ fail safe Serial #: 851751 <br />❑ <br />❑ NA <br />❑ <br />Red Dsl sensor <br />® <br />❑ positive shutdown Model: VR 794390-420 <br />❑ fail safe Serial #: 857667 <br />❑ NA <br />❑ <br />Drop tube with mechanical overfill at 95% <br />L011Drop <br />tube with mechanical overfill at 95% <br />Overfill prevention (see LG letter 150-1) <br />SERVICE <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System ❑ Other <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System O Other <br />Primary piping testing at: <br />❑ <br />psi <br />minutes <br />Secondary containment testing for: <br />UDC(s) Piping <br />Sump(s) Diesel UST(s) <br />® <br />Testing for the above components are next due by: <br />Note: Please be aware that 21 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 />❑X This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br />Observed functionality test of the above annular sensors. Passed. Observed secondary containment <br />test of the diesel UST. 7 inches of Hg vacuum was induced and held for 1.5 hours. Passed. Diesel <br />UST inventory was read at 6504 gallons. Facility may resume deposition of petroleum to the diesel <br />UST. <br />THIf JACILITY IS §UBJECT TO REINSPECTION AT ANYTIME AT EHD'S CURRENT HOURLY RATE. <br />P <br />WV <br />Receiv �� Title: <br />UST SERVICE REQUEST INSPECTION REPORT <br />Rev 10/06/10 <br />