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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sieov.ors/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAMR]FRVId-F Rli nrTVIT 1 VCUVrTrnu nuDnn r <br />Facility Name: <br />- --------'- - -_ <br />,<-- . u.v■ Lam. i avi" LXL' i lJRl <br />Inspection Date: <br />Lov� Cou�t�� <br />S-M(ZG <br />8[21 (00 <br />Facility Address: <br />ISSS GoLw-e <br />Con PIgo N <br />Service Request #: <br />5k-oos�lZ-�' <br />Onsite Service Technician's Name: <br />Leak detector <br />ICC gervice Technician/installer Certification #: <br />Manufacturer Training: <br />I<45�)tI"S rMAnDc"k- <br />❑ electronic Serial #: <br />I SD6,�-f1K74t-q T <br />A <br />SERVICE <br />L-6 € —W S.-fS t-s6vtC- -Fr� EM L Jj <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />E T AT- r PA-( 1 <br />❑ electronic Serial #: <br />d 0PfL 6 wT — n GST a YS s )e)ZD N <br />❑ line test programmed <br />❑ <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />Received <br />❑ electronic Serial #: <br />❑ <br />❑ line test programmed <br />Leak detector <br />❑ <br />❑ mechanical Model: <br />❑ <br />❑ electronic Serial #: <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 />EV <br />❑ fail safe Serial #: <br />❑ <br />❑ NA <br />❑ <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 />L-6 € —W S.-fS t-s6vtC- -Fr� EM L Jj <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />E T AT- r PA-( 1 <br />❑ Caldwell System ❑ Other <br />d 0PfL 6 wT — n GST a YS s )e)ZD N <br />Spill bucket ❑ minimum 5 gallon <br />❑ <br />❑ 1 hour hydrostatic ❑ Incon TS -STS <br />EHD Inspector:_ <br />❑ Caldwell System ❑ Other <br />Received <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 piping testing at: <br />❑ <br />psi <br />minutes <br />Secondary containment repairs for: <br />❑ <br />UDC(s) Piping <br />Sump(s) UST(s) <br />EV <br />Cold start of monitoring panel C -VR (&D Wev,? O <br />❑ <br />Corrosion protection <br />❑ <br />Other: see below <br />ylilhk,%W <br />L-6 € —W S.-fS t-s6vtC- -Fr� EM L Jj <br />--- 194SgF-i) <br />00 C61 <br />E T AT- r PA-( 1 <br />d 0PfL 6 wT — n GST a YS s )e)ZD N <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inspector:_ <br />(� n A ^ <br />Received <br />'u <br />D 23-04 <br />106/22/07 <br />