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otg4+rry c <br />�9li�oa.y'P <br />Ah <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.soclov.org/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />Arco AM/PM #5450 <br />Tuesday, August 7, 2012 <br />Facility Address: <br />Service Request #: <br />1617 W. Fremont St., Stockton <br />SR0064540 <br />Onsite Service Technician's Name: <br />ICC Service Technician/Installer Exp. Date: <br />Manufacturer Training: <br />Jose Carrasco <br />112/27/13 <br />VMI 9/6/13 <br />SERVICE <br />SERVICE <br />",:� Leak detector <br />nx <br />❑ mechanical Model: <br />El <br />Spill bucket ❑ minimum 5 gallon <br />� electronic Serial #: not replaced <br />❑ 1 hour hydrostatic O Incon TS -STS <br />y <br />❑ line test programmed <br />❑ Caldwell System ❑ Other <br />67 Leak detector <br />0 <br />❑ mechanical Model: <br />❑ <br />Spill bucket ❑minimum 5 gallon <br />N electronic Serial #: not replaced <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />y <br />❑ line test programmed <br />❑ Caldwell System ❑ Other <br />❑ <br />sensor <br />❑ positive shutdown Model: <br />❑ <br />Primary piping testing at: <br />❑ fail safe Serial #: <br />psi <br />❑ NA <br />minutes <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 />sensor <br />Testing for the above components are next due by: <br />❑ <br />❑ positive shutdown Model: <br />❑ fall safe Serial #: <br />❑ NA <br />Note: Please be aware that 2° containment components are required to be tested upon <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 />❑ <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 leak detectors at 10 psi at 3 gph, after the replacement of the PLLD <br />control module in the monitoring panel. Both passed. <br />I THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. I <br />EHD Inspector: <br />Received <br />EHD 2304 Rev. 04AW12 UST SERVICE REQUEST INSPECTION REPORT <br />