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ua ub zuvy THU ii: 31 FAX 2094603433 SJC ERD 0007/012 <br /> Ih, � <br /> SAN JOAQUIN COUNTY <br /> ., ENMONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Sfociden,CA 95202-3029 <br /> TefepboRe:(209)4603420 Fax:4209)468-3433-Web:www.sfyyov.orgleFM <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Fell Nsaw: laspWion e: <br /> 1~ �s b, (Z6`1 <br /> Faedl*AddreYn SorAm Requeal if: <br /> Do(v 21 '3 <br /> qqsft*9&%,h-&T$0hnkfarftNw : ICC Servos Technlclannnelaller E P,Date: M ufactum Tralning: <br /> Uer <br /> Cagi o VA,, p�;,&3qq 43 7 <br /> I. <br /> SERVICE SERVICE <br /> Lank detector Spill bucket LI minimum 5 gallon f <br /> ❑mechanical Model: <br /> C7 ❑ ❑1 how hydrostatic ❑ TS-STS <br /> ❑electronic Serial#' Q Caldwell System ❑OtheOther 1 ' <br /> ❑tine test programmed <br /> Leak detector Split bucket ❑mmkrexD 5 on <br /> ❑mechanical Model <br /> Q <br /> ❑electronic Serial ❑ ❑1 how hydrostatic 11 Ideon TESTS tlll <br /> �-- <br /> O line test programmed ❑Caldwell System Q Other <br /> Leg*detector- <br /> ❑ ❑mechanical - Model: _Spill bucket 11 minimum 5 gallon <br /> Q electronic Serial#•. El ❑ t hour hydrostatic ❑Inoon TS-STS <br /> ❑line test programmed ❑Caldwell System- CT Other <br /> sensor 8-- f4 n Primary piping testing at: <br /> positive shutdown Model: -103 <br /> ❑fail safe Serial#: - ---3D3 - ❑ —psi <br /> LINA VL 2p DWI-IbiwF itq&4 L minutes <br /> sensor Secondary containment testinij for <br /> ❑ 0 positive shutdown Model UDC(s) Piping <br /> LI fail safe Serial# Surnp(s) <br /> ❑NA UST(s) <br /> sensor ❑ Testing for the above components are next due by- <br /> Q O positive shutdown Model- <br /> 0 fag <br /> odel-❑fail Safe Serial xa;e:Reese beeaame the aam.mmm <br /> �are requrm m be meed u� <br /> SNA mdamtee.e.mr4eeae.mm euY Jemonnewwnaay. <br /> ❑ Drop tube with mechanical overfill al-95% ❑ Cold startof monitoring panel <br /> Ci —Drop tube with mechanical overfill at 954/4 ❑ Corrosion protection <br /> ❑ Overfill prevention-(see LG tetter 150-1) ❑ Other see below <br /> e <br /> THIS FACILITY IS SU CT TO REINSPECTION AT ANYTIME AT EHD'S CURRENT HOURLY RATE. <br /> EMD 2404 UST SERVICE REQUEST WSPECTION REPORT <br /> Rev I IWI49 <br />