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Triangle vInc. <br />2525 West Burbank Boulevard, Burbank, California 91505 <br />(818) 840-7020 FAX (818) 840-6929 <br />T.E.I. UST FACILITY INSPECTION/AUDIT SHEET <br />Facility: <br />Circle K #05446 Test Date: 5/28/97 <br />1403 COUNTRY CLUB BLVD <br />STOCKTON, CA 95204 <br />County: SAN JOAQUIN <br />Cross Street: Work M 50419 <br />t-- Stntlt, V r— Tvn i rNumber of <br />N- Not Present or observed <br />S- Satisfactory <br />Plus: <br />U= Unsatisfactory <br />Premium: <br />Fill Cover: <br />S <br />Fill Cap: <br />S <br />Fill Cap Seal: <br />S <br />Drop Tube: <br />S <br />Strike Plate: <br />G <br />V/R Cover: <br />S <br />V/R Cap: <br />S <br />V/R Seal: <br />S <br />V/R Dry Break: <br />S <br />Sub Pump: <br />S <br />Sub Pump Cover: <br />S <br />Overfill: <br />S <br />Overfill Mfgr: OPW <br />Comments: <br />C= Coaxial P= Pressure F= Flex <br />D- Dual A= Angle Cheek M= Metalic <br />N= No Stage t V= vertical Cheek <br />Fill Type: D <br />Product Line Type: P <br />Tank Swing Joint Type: F <br />Dispenser Swing Joint Type: F <br />N= Not Present <br />S- Satisfactory <br />U= Unsatisfactory <br />Impact Valve: S <br />Vertical Check Valve: <br />Fill Spill Containment: S <br />Fill Spill Mfgr: OPW <br />Dispenser Containment: S <br />Sub Pump Containment: S <br />Compliance Detail: (List items that need immediate attention.) <br />WATER IN ANNULAR SPACE ON ALL THREE TANKS. <br />Disp. Hoses <br />Regular: <br />4 8 <br />Plus: <br />4 8 <br />Premium: <br />4 8 <br />Diesel: <br />0 0 <br />Kerosene: <br />0 0 <br />® Stage II <br />B= Balance <br />A= Asist <br />System Type: B <br />Assist Mfgr: <br />