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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMETO <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax. (209)468-3433 Web:www.sigov.org/ehd <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM SERVICE R QUEST INSPECTION REPORT <br /> Facility Name: Inspection Date. <br /> mgv* 148, /lip lul-vid-1 <br /> Facility Address: Servife 141equist <br /> V1101 vi. hiab (ant I <br /> Onsite Service Technician's Name: ICC Service Technician/installer Certification#: al(fifagFer Tr <br /> SERVICE SERVICE <br /> Leak detector — Spill bucket 0 minimum 5 gallon <br /> F-1 0 mechanical Model: 0 0 1 hour hydrostatic 0 Incon TS-STS <br /> 0 electronic Serial#: 0 Caldwell System 11 Other <br /> El line test proffammed <br /> Leak detector Spill bucket El minimum 5 gallon <br /> El El mechanical Model: F-1 0 1 hour hydrostatic El Incon TS-STS <br /> El electronic Serial 0 Caldwell System F-1 Other <br /> El line test programmed <br /> . Leak detector Spill bucket 0 minimum 5 gallon <br /> 0 ❑ mechanical Model: [1 0 1 hour hydrostatic 0 Incon TS-STS <br /> 0 electronic Serial #: El Caldwell System 0 Other <br /> 0 line test programmed <br /> sensor Primary piping testing at: <br /> R 0 positive shutdown Model: 0 psi <br /> El fail safe Serial minutes <br /> 0 NA <br /> sensor Secondary piping testing at: <br /> 0 0 positive shutdown Model: 0 psi <br /> 0 fail safe Serial#: minutes <br /> El NA <br /> sensor Secondary containment repairs for: <br /> 0 0 positive shutdown Model: El UDC(s) Piping <br /> 0 fail safe Serial #: <br /> El NA Sump(s) UST(s) <br /> El Drop tube with mechanical overfill at 95% Cold start of monitoring panel <br /> D 0 <br /> Drop tube with mechanical overfill at 95% 0 Corrosion protection <br /> F-1 Overfill prevention(see LG letter 150-1) 0 Other: see below <br /> P^WeU 6 vi r-N (A f <br /> VI(y1711'��'Vf Ikj1W, VAIV <br /> S�I <br /> vi I r I <br /> V\0VWA <br /> THIS FACILITY IS SUBJECT TO REINSPECTION AT ANY TIME AT EHDIS CURRENT HOURLY RATE. <br /> sp tor: Recei Title: <br /> InAll <br /> c <br /> I <br /> EHD 23-04 <br /> Rev 06/22/07 <br />