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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />>'. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sogov.oro/ehd <br />,`F O <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection ate: <br />Quick N Save <br />Monday, August 13, 2012 <br />Facility Address: <br />Service Request #: <br />1901 S. EI Dorado St., Stockton <br />SR0064379 / SR0064953 <br />Onsite Service Technician's Name: <br />ICC Service Technician/Installer Exp. Date: <br />Manufacturer Training: <br />Joe Bartholdi <br />17/12/14 <br />VR x. 1/17/13 VMI X. 8/1/14 <br />SERVICE <br />SERVICE <br />Leak detector <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />l <br />❑ mechanical Mode: <br />❑ <br />❑ 1 hour hydrostatic ❑Incon TS -STS <br />❑ electronic Serial #: <br />❑ Caldwell System ❑ Other <br />❑ line test programmed <br />Leak detector <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />l <br />❑ mechanical Mode: <br />❑ <br />❑ 1 hour hydrostatic ❑Incon TS -STS <br />❑ electronic Serial #: <br />❑ Caldwell System ❑ Other <br />❑ line test programmed <br />sensor <br />Primary piping testing at: <br />❑ <br />❑ positive shutdown Model: <br />❑ <br />❑ fail safe Serial #: <br />minutes <br />❑ NA <br />sensor <br />Secondary containment testing for: <br />❑ <br />❑ positive shutdown Model: <br />UDC(s) Piping <br />❑ fail safe Serial #: <br />Sump(s) UST(s) <br />❑ NA <br />❑ <br />Testing for the above components are next due by: <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />Note: Please be aware that 2° containment components are required to be tested upon <br />❑ NA <br />installation, 6 months after, and every 36 months thereafter. <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Cold start of monitoring panel <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Corrosion protection <br />❑ <br />Overfill prevention (see LG letter 150-1) <br />❑X <br />Other: see below <br />X❑ <br />This UST facility is APPROVED to operate <br />❑ <br />This UST facility is NOT APPROVED to operate <br />Witnessed testing of 87 and 91 MLLDs at 3 gph at 10 psi. Both passed. Witnessed verification testing <br />of STP sump sensors, UDC sensors, and annular sensor, including sensor out and fail safe. All <br />passed. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY <br />%TIME AAT,eEHD'S CURRENT HOURLY RJATE.//' <br />EHCD Inspe or: ./ Rece y -A Title:/ -ell i <br />EHD 23-04 Rev. 10*i9bff2 1" UST SERVICE REQUEST INSPECTION REPORT <br />