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•td. <br />SAN JOAQUIN COUNTY <br />r ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br />Facility Name: <br />Inspection Date: <br />Flying J Travel Plaza #618 <br />Friday, March 11, 2016 <br />Facility Address: <br />Service Request #: <br />1501 N. Jack Tone Rd, Ripon, CA 95366 <br />SR0074324 <br />Onsite Service Technician's Name: <br />ICC Service Technician/installer Exp. Date: <br />Manufacturer Training: <br />Arturo Perez <br />11-10-17 <br />1 VR, s -13-17 <br />SERVICE <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />❑ line test programmed <br />❑ <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ electronic Serial #: <br />❑ <br />❑ line test programmed <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ NA <br />❑ <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ <br />❑ NA <br />Q <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ fail safe Serial #: <br />❑ NA <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Drop tube with mechanical overfill at 95% <br />❑ <br />Overfill prevention (see LG letter 150-1) <br />SERVICE <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System ❑ Other <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />❑ Caldwell System ❑ Other <br />Primary piping testing at: <br />❑ <br />psi <br />minutes <br />Secondary containment testing for: <br />UDC(s) Piping <br />Sump(s) UST(s) <br />❑ <br />Testing for the above components are next due by: <br />Note: Please be aware that 20 containment components are required to be tested upon <br />installation, 6 months after, and every 36 months thereafter. <br />Cold start of monitoring panel <br />❑ <br />Corrosion protection <br />Q <br />Other: see below <br />❑x This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br />On site to verify sensor functionality of the monitoring system after a cold start and for dispensers <br />replaced, verify that potential leaks in the dispenser piping will drain into the UDC's. Also for the <br />dispensers replaced a visual inspection for leaks of the reconnecting pipi► 'n the dispensers. Sensor <br />functionality was verified. All sensors passed. Observed liquid on the recunnecting piping in <br />dispensers 7-8 and 1-2. This needs to be corrected and reinspected by the EHD. Also after replacing <br />the remaining dispensers, EHD needs to reinspect verify all dispenser piping drains into the UDC's <br />and there is no active leaks in the reconnecting piping. <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inspector: I Re i By: TTitle: <br />� , STE4. <br />EHD 23-04 Rev. 04/19/12 UST SERVICE REQUEST INSPECTION REPORT <br />