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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.org/ehd <br /> UNDERGROUND STORAGE TANK ST PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection D te: <br /> PK. 1 DD /07:36/0-7 <br /> Facility Address: Service Request#: <br /> Se50 S . 4w S2oOs 00 <br /> Onsite Service Technician's Name: ICC SerAce Technician/Installer Certification#: Manufacturer Training: <br /> p(}JM� I U M&L OA41 0Gw <br /> SERVICE SERVICE <br /> eak detector Spill bucket El minimum 5 gallon <br /> mechanical Model: "::-'1C-7- LD 26 ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial #: 62LSJ- ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ElElmechanical Model: El 1 hour hydrostatic El Incon TS-STS <br /> ❑ electronic Serial#: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> Leak detector Spill bucket ❑ minimum 5 gallon <br /> ❑ ❑ mechanical Model: ❑ ❑ 1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ electronic Serial #: ❑ Caldwell System ❑ Other <br /> ❑ line test programmed <br /> sensor Primary piping testing at: <br /> ❑ ❑ positive shutdown Model: ❑ psi <br /> ❑ fail safe Serial#: minutes <br /> ❑ NA <br /> sensor Secondary piping testing at: <br /> ❑ ❑ positive shutdown Model: El —psi <br /> ❑ fail safe Serial#: minutes <br /> ❑ NA <br /> sensor Secondary containment repairs for: <br /> ❑ ❑ positive shutdown Model: ❑ UDC(s) Piping <br /> ❑ fail safe Serial #: Sump(s) UST(S) <br /> ❑ NA <br /> ❑ 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 F(b.q �--E-G 1A4i� <br /> reps — ye 2�8dlti a <br /> In P'� Ua1� �- H.�! <br /> rel e ` e -F in k � ;SM <br /> m � o `f 1 Ildr"l <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD ector: R ved By: Title: `� L <br /> VL GJ— 1 Cr <br /> EHQ 23-04 <br /> ao„ne/nim <br />