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°¢4u iyNk, <br />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.si9ov.orci/ehd <br />.•, gtrFOR�+ <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />Quick N Save <br />Monday, August 13, 2012 <br />Facility Address: <br />Service Request #: <br />1901 S. EI Dorado St., Stockton <br />SR0062629 <br />Onsite Service Technician's Name: <br />ICC Service Technician/Installer Exp. Date: <br />Manufacturer Training: <br />Joe Bartholdi 17/12/14 <br />VR x. 1/17/13 <br />SERVICE <br />SERVICE <br />Leak detector <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ mechanical Model: <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 />❑ mechanical Model: <br />❑ <br />❑ 1 hour hydrostatic ❑Incon TS -STS <br />❑ electronic Serial #: <br />❑ Caldwell System ❑ Other <br />❑ line test programmed <br />❑ <br />sensor <br />❑ positive shutdown Model: <br />❑ <br />Primaps piping testing at: <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 LIS letter 150-1) <br />❑Q <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 verification of positive shutdown on both the 87 and 91 turbines. Passed. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Insp ctor. _. Receive7 Title: <br />JI <br />EHD 23-04 Rev. 04/19112 UST SERVICE REQUEST INSPECTION REPORT <br />