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aQa"tN ° SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT ' <br />N. < <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd <br />0•R�`P <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />AT&T -UE042 <br />Tuesday, June 28, 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 />Anthony Grijalva (5250443 -UI) 15/3/2013 <br />❑ mechanical Model: <br />1 N/A <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 />0 <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 M <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 />❑ 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 />0 <br />50 psi <br />60 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 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 />0 This UST facility is NOT APPROVED to operate <br />Observed soap test of the two replaced basement primary fuel lines after holding and maintaining <br />pressure at 50 p.s.i. for (at least) one hour. Passed. M. McGee from Stockton Fire also on site. <br />-- The pan and liquid leak sensor proposed in this service request has not been installed yet. Facility <br />is not approved to operate until the leak sensor has been tested for functionality and all the conditions <br />of the service request permit SR0062275 have been met. <br />-- The old pipings were disposed as hazardous waste under manifest #002135854JJK to Ecology. <br />Submit a copy of the signed manifest to EHD. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EH nspectorRe lved By: Title: <br />7 23-04 UST SERVICE REQUEST INSPECTION REPORT <br />Rev 10/06/10 <br />