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uv if <br />C <br />SAN JOAQUIN COUNTY <br />y yX ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />` Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />AT&T-UE042 <br />Friday, July 1, 2011 <br />Facility Address: <br />Service Request #: <br />345 N. San Joaquin, Stockton <br />SR0062275 <br />Onsite Service Technician's Name: <br />ICC Service Technicianlinstaller Exp. Date: <br />Manufacturer Training: <br />Carl Wayne Hendes 5252923UT <br />7/28/2012 <br />VR A25001 6/6/2013 <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 />87 PIPING sensor <br />0 <br />❑ positive shutdown Model: VR 794380-208 <br />❑ fail safe Serial #: 882703 <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 LG letter 150-1) <br />0 This UST facility is APPROVED to operate <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 ❑ 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 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 />Technician tested the newly installed VR liquid sensor and verified functionality. Alarm history pulled <br />verified no cold start was done to the monitoring system. <br />SJC EHD was notified (at least 48 hours in advance) on 6/24/2011 of the testing of the primary line on <br />6/28/2011, and on 6/28/2011 of the sensor testing inspection on 7/1/2011. <br />_ THUACILITY ISS SUB2!�CT TO REINSPECTION AT An TIME AT EHD'S CURRENT HOURLY RATE. <br />EHJU I spec / n Receiv By: -i I Title: <br />ENO 23-0 // / / �/ UST SERVICE REQUEST INSPECTION REPORT <br />Rev 10/064/ {/ <br />