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A u A <br />SAN JOAQUIN COUNTY <br />yENVIRONMENTAL HEALTH DEPARTMENT <br />j hu ( j 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd <br />;.:Oft <br />UNDERGROUND <br />` <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />Quick N Save <br />Monday, August 6, 2012 <br />Facility Address: <br />Service Request #: <br />1901 S. EI Dorado St., Stockton <br />SR0064953 <br />Onsite Service Technician's Name: <br />ICC Service Technician/Installer Exp. Date: <br />Manufacturer Training: <br />Jarod Burke <br />16/2014 <br />SERVICE <br />SERVICE <br />Leak detector <br />❑ mechanical Model: <br />87 -octane Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ electronic Serial #: <br />© <br />D 1 hour hydrostatic ❑Incon TS -STS <br />❑ line test programmed <br />❑ Caldwell System ❑ Other <br />Leak detector <br />91 -octane Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />❑X <br />0 1 hour hydrostatic ❑Incon TS -STS <br />❑ line test programmed <br />❑ Caldwell System ❑ Other <br />❑ <br />sensor <br />❑ positive shutdown Model: <br />Primary piping testing at: <br />❑ fail safe Serial #: <br />psi <br />60 minutes <br />❑ NA <br />sensor <br />Secondary containment testing for: <br />❑ <br />❑ positive shutdown Model: <br />UDC(s) 87 91 Piping <br />❑ fail safe Serial #: <br />Sump(s) UST(s) <br />O NA <br />Testing for the above components are next due by: <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />N/A <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 />❑Q <br />Other: see below <br />❑ <br />This UST facility is APPROVED to operate <br />❑x <br />This UST facility is NOT APPROVED to operate <br />Witnessed secondary containment testing of the 87 and 91 lines at 5 psi for 60 minutes. Passed. <br />Witnessed primary piping testing of the 87 and 91 lines at 50 psi for 60 minutes. Passed. Witnessed <br />piping soap test. Passed. Witnessed one hour hydrostatic testing of the existing 87 and 91 spill <br />containers. Passed. Verified adequate fit of the footprint of the new dispensers on the previously <br />existing dispenser pans. <br />THIS FACILI S SUBJECT TO REINSPECTION AT AN13nd& AT EHQXrCt#RRENT HOURLY RATE. <br />EHD I ector. _ R ed By: Title: f"e44_reT__ <br />EHD 2304 Rev. 04/19/12 UST SERVICE REQUEST INSPECTION REPORT <br />