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V I tY <br /> ' ?� SAN JOAQUIN COUNTY <br /> H -r. ENVIRONMENTAL HEALTH DEPARTMENT <br /> .. '. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sictov.org/ehd <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> Arco AM/PM Tuesday, June 7, 2016 <br /> Facility Address: Service Request#: <br /> 1617 W Fremont St. Stockton, CA 95203 SR0074508 <br /> Onsite Service Technician's Name: ICC Service Tech nician/Installer Exp.Date: Manufacturer Training: <br /> Tim Adams I ICC Ser.Tech - 8205730 -5/26/17 1 Incon-#4992713705-Exp 9/1/17 <br /> SERVICE SERVICE <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ mechanical Model: <br /> ❑ ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ mechanical Model: <br /> ❑ ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> sensor <br /> E] ❑ positive shutdown Model: ElPrimaps piping testing at: <br /> ❑fail safe Serial#: <br /> ❑ NA minutes <br /> sensor Secondary containment testing for: <br /> ❑ ❑ positive shutdown Model: UDC(s) Piping <br /> ❑fail safe Serial#: 87 Master Sump(s) 87 Master UST(s) <br /> ❑ NA <br /> sensor 0 Testing for the above components are next due by: <br /> ❑ ❑ positive shutdown Model: October 15th, 2016 <br /> ❑fail safe Serial#: Note: Please be aware that 20 containment components are required to be tested upon <br /> ❑ NA installation,6 months after,and every 36 months thereafter. <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Cold start of monitoring panel <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Corrosion protection <br /> ❑ Overfill prevention(see LG letter 150-1) ❑ Other: see below <br /> ❑X This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> On site to conduct a service request for 1617 W Fremont St. <br /> Tests conducted: <br /> -24-Hour Hydrostatic test (Incom) on the 87 master tank top sump directly below the repaired manhole <br /> cover and ring (after concrete has set). -Secondary containment testing on 87 master underground <br /> storage tank directly below the repaired manhole cover and ring (after concrete has set). Used <br /> vacuum testing at 0.135357 PSI (7 mm Hg). <br /> Results: <br /> -87 Master tank top sump hydrostatic test: Failed. Three attempts made total. Rescheduling test TBA. <br /> -87 Master tank secondary containment test: Passed. First attempt. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD Inspect ived B : Title- <br /> I S -�eS�es <br /> EHD 23-04 Rev.04/19/12 UST SERVICE REQUEST INSPECTION REPORT <br />