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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT- <br />Stockton, <br />EPARTMENTStockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Pax: (209) 468-3433 Web: www.sjgov.org/ehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE xEvuEN i > 1vz!orr.%. I. � r wixa <br />Facility Name: lospectioate: <br />n <br />USA CTAS S4A- -jO" l0 8 2Z2 - 1 Z D - <br />Facility Address: Service Request #: <br />2132 4r� bs'a QJ. g�I� <br />Onsite Service Technician's Name: ICC Service Tec nician/l staller rtificatinn #: Manufacturer Training <br />R�� tl l U C�1 <br />o t,._ 1rao._ <br />SERVICE <br />Leak detector <br />L� <br />❑ mechanical Model: <br />❑ <br />❑ electronic Serial #: <br />Y4 <br />❑ line test programmed <br />(v <br />Leak detector <br />t",'— Aown <br />❑ mechanical Model: <br />❑ <br />❑ electronic Serial #: <br />&L4- , <br />❑ line test programmed- <br />rogrammedLeak <br />ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />Leakdetector <br />❑ mechanical Model: <br />❑ <br />❑ electronic Serial #: <br />❑ line test ro rammed <br />ty,s • sensor eS&/I— <br />positive shutdown Model: ' qq Ll (7 —20 $ <br />❑ <br />'fail safe Serial #: <br />❑ NA <br />sensor <br />❑ <br />❑ positive shutdown Model: <br />❑ <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 />61 Spill bucket Xminimum 5 gallon <br />L� <br />1 hour hy4renft- El Incon TS -STS <br />01 <br />El Caldwell System 90ther hoop - <br />Y4 <br />SO7 Spill bucket 'minimum 5 gallon <br />(v <br />KI hour hy4rojatj�c ❑ Incon TS -STS <br />t",'— Aown <br />❑ Caldwell System lac Other <br />B VLAlel . i v <br />G1 ( Spill bucket Wminimum 5 gallon <br />&L4- , <br />;K1 hour hic ❑ Incon TS -STS <br />ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />El Caldwell Systei ` l Other 2 . <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 />❑ <br />Cold start of monitoring panel <br />❑ <br />Corrosion protection <br />❑ <br />Other: see below <br />V <br />EHD 23-04 <br />1/3/07 <br />Iv al rttj <br />01 <br />L <br />Y4 <br />f Q�1 <br />So^ Sof <br />t",'— Aown <br />B VLAlel . i v <br />-,xl)of <br />&L4- , <br />THIS FACILITY IS SUBJECT TO REINSPECTION AT <br />ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inspe r.By: <br />/0 t/ ' ` <br />Title: <br />V <br />EHD 23-04 <br />1/3/07 <br />