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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEN', r <br /> 304 East Weber Avenue,3rd Floor, Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE REQUEST INSPECTION REPORT <br /> Facility Name: Inspection Date: <br /> Ctq Ste- 3-23-01 <br /> Facility Address: Service Request#: <br /> -1-1 O'D (J cr,, %0(je�$$Z <br /> Onsite Service Technician's Name: ICC Service 7leWmAd[n/Installer Certification#: Manufacturer Training: <br /> Jim 9ki <br /> SERVICE SERVICE <br /> Leak detector <br /> ❑ mechanical ModelSpill bucket ❑ minimum 5 gallon <br /> : <br /> ❑ <br /> electronic Serial ❑ El hour hydrostatic 11 Incon TS-STS <br /> ❑ Caldwell System El Other <br /> El line test programmed <br /> Leak detector <br /> 11 mechanical Model: Spill bucket ❑ minimum 5 gallon <br /> F-1 ❑ electronic Serial ElEl1 hour hydrostatic ❑ Incon TS-STS <br /> ❑ line test programmed El Caldwell System ❑ Other <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#: <br /> minutes <br /> ❑ NA <br /> sensor <br /> ❑ <br /> El positive shutdown Model: El Secondary piping testing at: <br /> si <br /> El fail safe Serial#: p <br /> minutes <br /> El 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 <br /> D J <Z7 STY H_Ik� <br /> THIS FACILITY IS SUBJECT TO REINSPE I9 NY TIME AT EHD'S CURRENT HOURLY RATE. <br /> EHD In ecttor, Rece v itle: <br /> EHD 23-04 <br /> 1/3/07 <br />