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03/2542009 13:26 20947323PAGE 06/06 <br /> MARCH LANE 76 <br /> SAN JOAQWN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone. (209)468-3420 Fax, (209)468-3433 We&WWw.sjjQv.org1.ehd <br /> UNDERGROUND.STORAGE,TANK ST) PROGRAM SERVICE RE2UEST INSPECTION REPORT <br /> FaclUty Name: Inspection Date: <br /> Facility Address: 0 2 <br /> Semi&"west#: <br /> 34 C)n,565 <br /> &A <br /> Onsite Service Technician'sLqfNam-e:-. [CC Service Technician/installer Certifleation 4- 1 Manuf��rer Training:r L411ch <br /> SERVICE SERVICE <br /> Leak detector ........ <br /> Mmechanical Model: Spill bucket 0 minimum 5 gallon <br /> 0 electronic Sena]#: I hour hydrostatic 13 Incon TS-STS <br /> 0 line test programmedIC>9 97 0 Cald ell 3, 0 her <br /> _ . 304* . <br /> I Leak detector <br /> (mechanical Model: Aj /6..L-1 V Spill bucket 0 minimum 5 gallon <br /> 0 electronic Serial#: jj(2 _C256,_ 13 1 hour hydrostatic 0 Thcon TS-STS <br /> 0 line test p2jammed Ips , Caldwell System 0 Other <br /> j�i�ef, Zeak detector <br /> " 3,mcchanical Model: Spill bucket 0 minimum 5 gallon <br /> 0 electronic Serial ❑ 0 1 hour hydrostatic 0 Incon TS-STS <br /> - '0 line test 2rogrammedC El Caldwell System 0 Other <br /> =W I 13 <br /> -sensor <br /> 0 positive shutdown Model: Primary piping testing at: <br /> ❑ 13 fail safe Serial 0 psi <br /> ' <br /> ❑ NA minutes <br /> sensor <br /> El positive shutdown Model: Secondary piping testing at: <br /> 0 fail safe Serial#: psi <br /> 0 NA minutes <br /> sensor <br /> 0 positive shutdown Model: Secondary containment repairs for: <br /> ❑ El fail safe "` ❑ UDC s _ <br /> Serial. Piping <br /> ❑ 0 NA Drop tube with mechanical overfill sump(s) UST(s) <br /> — I at 95% ❑ Cold start of monitoring panel <br /> ❑ 9 5']% <br /> Drop tube with mechanical overfill at 0 El Corrosion protection <br /> EJ Overfill prevention(see.LG letter 150-1) Other—: see bel <br /> 4*L <br /> THIS FACILITY IS SUBJECT TO. REINSPECTION AT ANY TIME AT EHDIS,.CURRENT HOURLY RATE. <br /> END Inapcctor rrRccrj- y: <br /> 0- Tits:J0 <br /> ).23-04 <br /> nAMM7 <br />