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SAN JOAQUIN COUNTY <br />�: .—ter . •�i <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.ora/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />Nella - Olympian #427 <br />Wednesday, December 8, 2010 <br />Facility Address: <br />Service Request #: <br />3300 Waterloo Road, Stockton <br />SR0061572 <br />Onsite Service Technician's Name: <br />ICC Service Techniciannnstaller Exp. Date: <br />Manufacturer Training: <br />Juan Delgado <br />15246958UI 10/22/2012 <br />OPW EVR Phase 1 10/2/2012 <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 />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ NA <br />❑ <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ <br />❑ fail safe Serial #: <br />® <br />❑ NA <br />❑ <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ NA <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Overfill prevention (see LIS letter 150-1) <br />❑ This UST facility is APPROVED to operate <br />SERVICE <br />DSL Spill bucket ❑ minimum 5 gallon <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 ❑ Other <br />Primary piping testing at: <br />❑ <br />psi <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 20 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 />0 This UST facility is NOT APPROVED to operate <br />Observed hydrostatic test on the newly replaced OPW-2100 series spill bucket (P/N C05097M) for the <br />diesel UST using Caldwell System. Passed. Verified corrosion protection. <br />This UST is not approved to operate and the discontinuance of petroleum deposition to the diesel spill <br />bucket remains in effect until all the permit conditions of SR0061572 have been met (secondary <br />containment test of the diesel tank and functionality test of the annular sensors to be replaced). <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY T ME4T EHD'S CURRENT HOURLY RATE. <br />EHspedtor. _ /n ^� ReceivedB . 17�) Title: <br />EHD 23-64 U( UST SERVICE REQUEST INSPECTION REPORT <br />Rev 10/06/10 �/ <br />