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°¢Qulnr 'c SAN JOAQUIN COUNTY <br />y ENVIRONMENTAL HEALTH DEPARTMENT <br />N t <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sugov.org/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />A. Teichert & Son, Inc. <br />Tuesday, October 12, 2010 <br />Facility Address: <br />Service Request: <br />120 Frank West Cir., Stockton CA <br />SR0061155 <br />Onsite Service Technician's Name: <br />ICC Service Technician/Installer Exp. Date: <br />Manufacturer Training: <br />Gerado Guzman Jr. <br />108/09/12 <br />VR = 7/6/11 <br />SERVICE <br />Leak detector <br />O <br />❑ mechanical Model:VR 848480-003 (w/o Swiftcheck) <br />N electronic Serial #: N/A <br />❑ line test programmed <br />❑ <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />❑ <br />❑ line test programmed <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ <br />❑ electronic Serial #: <br />❑ line test programmed <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ <br />❑ NA <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ <br />❑ fail safe Serial #: <br />❑ <br />❑ NA <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 />SERVICE <br />87 Spill bucket 9 minimum 5 gallon <br />❑ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />0 Caldwell System ❑ Other <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 20 containment components are required to be tested upon <br />installation, 6 months after, and every 36 months ttrereafter. <br />❑ <br />Cold start of monitoring panel <br />❑ <br />Corrosion protection <br />❑ <br />Other: see below <br />On site to witness the PLLD bulk delivery leak detector test after repairing the check valve and <br />purging the line. The PLLD functioned normally and detected a three gallon per hour leak. Also <br />verified the replaced spill container on the 87 unleaded product held five gallons and passed a 30 <br />min. Caldwell test. A form C has been submitted by the contractor. <br />THIS 173C414TY IS SUBJECT TO REINSPE TION AT AAY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD ector: <br />R04d d B : <br />E 23-04 UST SERVICE REQUEST INSPECTION REPO <br />Rev 06/01/10 <br />