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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.si2ov.orehd <br />Facility Name: inspection Date: <br />Qat &W 1-41 Sjo� <br />Facility Address: Service Request #: <br />MMM SWEET AAIWF�;:rA <br />Onsite Service Technician's Name: ICC Service Technician/Installer Certification #: Manufacturer Training: <br />_JeSsE✓ ArwvM I <br />SERVICE <br />Leak detector <br />13 <br />El mechanical Model: <br />0 1 hour hydrostatic 0 Incon TS -STS <br />F-1 electronic Serial #: <br />0 Caldwell System 0 Other <br />0 line test 2roEammed <br />Spill bucket El minimum 5 gallon <br />Leak detector <br />El I hour hydrostatic 0 Incon TS -STS <br />El mechanical Model: <br />0 Caldwell System 0 Other <br />F1 electronic Serial #: <br />- Spill bucket El minimum 5 gallon <br />0 line test programmed <br />0 1 hour hydrostatic El Incon TS -STS <br />. Leak detector <br />0 Caldwell System El Other <br />0 mechanical Model: <br />Primary piping testing at: <br />El electronic Serial <br />psi <br />El line test programmed <br />minutes <br />sensor <br />❑ <br />0 positive shutdown Model: <br />4' psi <br />0 fail safe Serial #: <br />6 0 minutes <br />El NA <br />Secondary containment repairs for: <br />sensor <br />❑ <br />0 positive shutdown Model: <br />Sump(s) VST(s) <br />0 fail safe Serial #: <br />Cold start of monitoring panel <br />El NA <br />Corrosion protection <br />sensor <br />El <br />El positive shutdown Model: <br />n fail safe Serial #: <br />0 NA <br />El <br />_ Drop tube with mechanical overfill at 95% <br />EDrop tube with mechanical overfill at 95% <br />Overfill prevention (see LG letter 150-1) <br />SERVICE <br />Spill bucket 0 minimum 5 gallon <br />D <br />0 1 hour hydrostatic 0 Incon TS -STS <br />THIS FACILITY IS S UBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />0 Caldwell System 0 Other <br />Spill bucket El minimum 5 gallon <br />El <br />El I hour hydrostatic 0 Incon TS -STS <br />0 Caldwell System 0 Other <br />- Spill bucket El minimum 5 gallon <br />0 <br />0 1 hour hydrostatic El Incon TS -STS <br />0 Caldwell System El Other <br />Primary piping testing at: <br />0 <br />psi <br />minutes <br />Secondary piping testing at: plo-e, <br />4' psi <br />6 0 minutes <br />Secondary containment repairs for: <br />0 <br />UDC(s) Piping <br />Sump(s) VST(s) <br />0 <br />Cold start of monitoring panel <br />0 <br />Corrosion protection <br />El <br />Other: see below <br />EHD 23-04 <br />Rev 06/22/07 <br />Mjjjjjjjjjrjjjj!!!"�i� <br />YTU�?7 A�MU—C� <br />THIS FACILITY IS S UBJECT TO REINSPECTION AT ANY TIME AT EHD'S CURRENT HOURLY RATE. <br />EHD Inspector: <br />EHD 23-04 <br />Rev 06/22/07 <br />