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hqu ity <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue , Stockton , CA 95205 -6232 <br /> lip ap <br /> 009 pop Telephone: (209) 468-3420 Fax: (209) 468-3433 Web : www . slgov. org/ehd <br /> A � % FORS <br /> UNDERGROUND STORAGE TANK ( UST ) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date : <br /> Chevron #208117 Friday , May 10 , 2019 <br /> Facility Address : Service Request #: <br /> 755 S Tracy Blvd b v d 0 $ 0 3 <br /> Onsite Service Technician' s Name : ICC Service Technician/Installer Exp. Date : Manufacturer Training : <br /> Steve Parmenter 2/24/21 0 P 4/4/21 <br /> SERVICE SERVICE <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> El mechanical Model : <br /> ❑ El El hour hydrostatic [I Incon TS-STS <br /> El electronic Serial # : <br /> ❑ line test programmed El Caldwell System ❑ Other <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> [I mechanical Model : <br /> ❑ El El hour hydrostatic ❑ Incon TS-STS <br /> El electronic Serial # : ❑ Caldwell System ❑ Other <br /> El line test programmed . <br /> sensor <br /> ❑ Primary❑ positive shutdown Model : piping testing at : <br /> El <br /> ❑ fail safe Serial # : <br /> minutes <br /> ❑ NA <br /> sensor Secondary containment testing for: <br /> ❑ ❑ positive shutdown Model : UDC (s) Piping <br /> ❑ fail safe Serial # : Sump (s) UST(s ) <br /> ❑ NA <br /> sensor ❑ Testing for the above components are next due by : <br /> El ❑ positive shutdown Model : <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 /> ❑X 87 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 /> ❑ This UST facility is APPROVED to operate ❑ This UST facility is NOT APPROVED to operate <br /> On site to verify that overfill prevention equipment was set to 95 % or lower of the tank volume . <br /> Furthermore verification of ball floats was done . Service technician on site stated that no ball floats <br /> were installed in the system . <br /> Measurements at the time of inspection for the OPW shut off valve . <br /> Length of the riser= 58 inches <br /> length of the manway = 6 inches <br /> Total length from bottom to top of the tank = 180 inches <br /> This service request is complete at this time . The facility may operate their 87 product tank system at <br /> this time . <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD ' S CURRENT HOURLY /RATE . <br /> EHD Inspector: �GZQ�P�L Received By: Title : s2V�Ge / �GVI�'IIG/G�yI <br /> EHD 23-04 Rev. 04/19/12 UST SERVICE REQUEST INSPECTION REPORT <br />