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• SAN JOAQUIN COUNTY a -- - - -- -- <br /> ENVIRONMENTAL HEALTH DEPARTMEN <br /> rd r, Stockton,CA 95202-2708 <br /> Telephone: (209)468-3420 Far. (209)468-3433 Web:www.sjgov.org/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection 72110 -?te: <br /> R 4 N L 14-D S�N tit ; 5�L. //1�Q rleo {— b 7z 1 l D -? <br /> Facility Address: Service Request#: <br /> 1i121 S. A- l r ppr f' Vv,4 1 �vG IL f U.�J S /ZOC� <br /> Onsite Service Technician's Name: ICC S rvice Tchnician/Installer Certification#: Manufacturer Training: <br /> rr-r( MU ALt�h ( a�D er A 0.0 // <br /> I <br /> SERVICE 0;0 p SERVICE <br /> Ob Leak detector ('@ �j Spill bucket minimum 5 gallon <br /> mechanical Model:STP A414 - € <br /> r` <br /> El electronic Serial#: Ot [9/o7 6i � 0 1 hour hydrostatic ❑ TS-STS <br /> —�---- -s- ❑ Caldwell System ❑ Other� <br /> ❑ line test programmed 1, cerl-1 <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ mechanical Model: <br /> ❑ ❑ 131 hour hydrostatic ❑ Incon TS-STS <br /> E3 electronic Serial#: <br /> ❑ Caldwell System <br /> ❑ line test programmed <br /> Leak detector Spill bucket <br /> ❑ ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic <br /> ❑ electronic Serial#: ❑ Caldwell System <br /> ❑ line test programmed <br /> -11 _sensor �-fP 11 <br /> R positive shutdown Model: 0-761"1 386 ` Z 0$ Primary piping testix <br /> Mail safe Serial #: (0'7 (, 0`)Gi ❑ psi <br /> minutes <br /> ❑ NA <br /> sensor Second piping tes <br /> ❑ positive shutdown Model: p p g <br /> ❑ E3 psi <br /> ❑ fail safe Serial #: <br /> minutes <br /> ❑ NA <br /> sensor i ,: •r: r-,1.��rt - --- <br /> ❑ positive shutdown Model: Secondary contaixlme <br /> El UDCt <br /> ❑ fail safe Serial #: ❑ 1 "l "'"' <br /> ❑ NA Sump <br /> ❑ Drop tube with mechanical overfill at 95% JDOOth'cr: <br /> start of monitori <br /> ❑ Drop tube with mechanical overfill at 95% osion protection <br /> ❑ Overfill prevention (see LG letter 150-1) see below <br /> �NSi � � Pr /12toJ fns f�G1'el M2GIn41i GQ' t-:C.r�.>,F: r;Liil-:r1 - -.._ <br /> rr <br /> al eCJ-w 7YA vC, LF 9/1 Bi / o :t : lilt <br /> I 1,11 i',L�i[hI <br /> NG Fn• �/rA1/f ht✓�r�0�1 r "P J ` Ga 1L a 1 ur; 1u:--, hr1 <br /> THIS FACILITY IS SUBJECT TO REINSPEqjq&tAT EHD'S CURRENT HOURLY RATE. <br /> EHD Ins tor: Recei d Title: <br /> EHD 23-04 <br /> 1/3/07 <br />