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SAN JOAQUIN COUNTY <br /> 9 <br /> 6�. ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue,Stockton, CA 95205-6232 <br /> Telephone. (209)468-3420 Fax. (209)468-3433 Web:www.sic <br /> 1. H <br /> lov.oEp", 71F <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE REQUEST INSPECTION REPORT, <br /> Facility Name: Inspection Date: <br /> Pilot Travel Center, LLC April 28, 2017 <br /> Facility Address: Service Request#: <br /> 1501 North Jack Tone Road, Ripon, CA 95366 SR0076380 (Addendum) <br /> Onsite Service Technician's Name: ICC Service Technicianlinstaller Exp.Date: Manufacturer Training: <br /> [James Blaine 7/14/2018 Incon 9/29/2018 <br /> SERVICE SERVICE <br /> Leak detector <br /> 11 mechanical Model: Spill bucket 0 minimum 5 gallon <br /> E <br /> ] 11 electronic Serial 13 0 1 hour hydrostatic 0 Incon TS-STS <br /> 0 line test programmed 0 Caldwell System 0 Other <br /> Leak detector <br /> Spill bucket 0 minimum 5 gallon <br /> Ej 0 mechanical Model: <br /> El <br /> 0 electronic Serial 0 1 hour hydrostatic 0 Incon TS-STS <br /> 0 line test programmed 0 Caldwell System 0 Other <br /> sensor Primary piping testing at: <br /> 171 [1 positive shutdown Model: psi <br /> 0 fail safe Serial <br /> 0 NA minutes <br /> sensor Secondary containment testing for: <br /> E] 0 positive shutdown Model: Satellite#22 UDC(s) Piping <br /> 0 fail safe Serial T5-91 STP Sumps) UST(S) <br /> 0 NA sensor Testing for the above components are next due by: <br /> ❑ 0 positive shutdown Model: October 2017 <br /> 0 fail safe Serial#: Note:Please be aware that 21 containment components are required to be tested upon <br /> 0 NA installallon,6 months after,and every 36 months thereafter. <br /> ❑ Drop tube with mechanical overfill at 95% ❑ Cold start of monitoring panel <br /> El Drop tube with mechanical overfill at 95% ❑ Corrosion protection <br /> ❑ Overfill prevention(see LG letter 150-1) El Other:see below <br /> This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> On site to witness secondary containment testing of the underground storage tank, T-5 premium <br /> unleaded submersible turbine pump (STP) sump and the satellite under dispenser containment(UDC) <br /> No. 22 sump. The satellite UDC No. 22 and the T-5 premium unleaded STP sumps passed the <br /> fifteen-minute Incon tests. This UST facility is approved to operate. Testing for the satellite UDC No. <br /> 22 and T-5 premium unleaded STP sumps are next due in October 2017. <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHDpectora w-med Received Title: <br /> EHO 23-04 Rev.04/19112 <br /> UST SERVICE REQUEST INSPECTION REPORT <br />