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I- <br />"I <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMEOT <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 QUEST INSPECTION REPORT <br />Facility Name: A Inspection Date: <br />11 1- L <br />", <br />Facility Address: Service Request <br />17 C -p— 0,0 f <br />771Y� 01 qp-" Etvd <br />Onsi-te-Ae—rvice Technician's Name: ICC Service Technician/Installer Cert'fl ation #: Manufacturer Training: I <br />IAAJ,j 1A111/1)1fLAVN I W 611[o-1--- Wfin k4 ®i 111ma <br />UZEM <br />SERVICE <br />Leak detecto■ r <br />0 El I hour hydrostatic 0 Incon TS -STS <br />El mechanical Model: <br />0 electronic Serial <br />0 <br />0line t"t «!7 -« <br />Leak detector <br />El mechanical Model: <br />1:3 <br />El electronic Serial #: <br />El line test programmed <br />Leak detecto■ r <br />0 <br />0 mechanical Model: <br />F-1 electronic Serial <br />El line test _programmed <br />El <br />sensor <br />0 positive shutdown Model: <br />0 fail safe Serial #: <br />❑ <br />0 N -A__ <br />sensor <br />■ <br />El positive shutdown Model: <br />-1 <br />D <br />F■ ail safe Serial #: <br />f <br />0 <br />0 NA <br />• <br />■ <br />■ <br />Drop tube with mechanical overfill at 95% <br />Drop tube with mechanical overfill at 95% <br />SERVICE <br />Spill bucket 0 minimum 5 gallon <br />0 El I hour hydrostatic 0 Incon TS -STS <br />El Caldwell System El Other <br />Spill bucket 0 minimum 5 gallon <br />0 <br />El I hour hydrostatic 0 Incon TS -STS <br />El Caldwell System El Other <br />Spill bucket 0 minimum 5 gallon <br />1:3 <br />0 1 hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System 0 Other <br />Primary piping testing at: <br />0 <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 />Cold start of monitoring panel <br />D <br />Corrosion protection <br />0 <br />Other: see below <br />iI <br />EHD 23-04 <br />Rev 06/22/07 <br />WFUMEW&RIMMIA17mr �111 <br />TO REINSPECTION AT ANY TIME AT EHDS CURRENT HOURLY RATE. <br />iI <br />EHD 23-04 <br />Rev 06/22/07 <br />