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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMER <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.sigov.orehd <br />UNDERGROUND STORAGE TANK (UST) PROGRAM SERVICE UEST INSPECTION REPORT <br />Facility Nam Inspection Date: <br />Facility Adess: vv� Service Request <br />li"A q0vl SP Obo;— <br />Technician's Name: F ICC Service Technician/Installer Certification #: <br />R -M <br />SERVICE <br />Leak detecto■ r <br />— Spill bucket El minimum 5 gallon <br />F-1 mechanical Model: <br />0 1 hour hydrostatic 0 Incon TS -STS <br />r-1 electronic Serial #: <br />0 Caldwell System F-1 Other <br />El line test programmed— <br />Spill bucket F-1 minimum 5 gallon <br />Leak de■ tector <br />0 1 hour hydrostatic 0 Incon TS -STS <br />13 mechanical Model: <br />El Caldwell System 0 Other <br />R electronic Serial #: <br />— Spill bucket D minimum 5 gallon <br />0 line test programmed <br />0 1 hour hydrostatic El Incon TS -STS <br />Leak detector <br />■ <br />0 mechanical Model: <br />Primary piping testing at: <br />0 electronic Serial #: <br />— psi <br />0 line test programmed <br />minutes <br />fh#A 5>"K0)9ensr <14 <br />o <br />Secondary piping testing at: <br />,%positive shutdown Model: <br />psi <br />Z fail safe Serial#."1�31 <br />minutes <br />0 NA <br />Secondary containment repairs for: <br />❑ <br />UDC(s) Piping <br />Sump(s) UST(s) <br />■ <br />Cold start of monitoring panel <br />El <br />Corrosion protection <br />sensor <br />Other: see below <br />0 positive shutdown Model: <br />El fail safe Serial #: <br />DNA <br />Drop tube with mechanical overfill at 95% <br />Drop tube with mechanical overfill at 95% <br />SERVICE <br />— Spill bucket El minimum 5 gallon <br />El <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System F-1 Other <br />Spill bucket F-1 minimum 5 gallon <br />❑ <br />0 1 hour hydrostatic 0 Incon TS -STS <br />El Caldwell System 0 Other <br />— Spill bucket D minimum 5 gallon <br />El <br />0 1 hour hydrostatic El Incon TS -STS <br />0 Caldwell System El Other <br />Primary piping testing at: <br />El <br />— psi <br />minutes <br />Secondary piping testing at: <br />El <br />psi <br />minutes <br />Secondary containment repairs for: <br />❑ <br />UDC(s) Piping <br />Sump(s) UST(s) <br />0 <br />Cold start of monitoring panel <br />El <br />Corrosion protection <br />0 <br />Other: see below <br />EHD 23-04 <br />Rev 06/22/07 <br />rl <br />Lo <br />EHD 23-04 <br />Rev 06/22/07 <br />